Protect your practice from governmental and third-party payer audits. Auditing Physician Services: Verifying Accuracy in Physician Services and E/M Coding explains complex reimbursement and coding rules and provides audit sheets for key, high-risk areas including E/M services.
Medical practices face major risks if they don't code physician services accurately. Practices that violate the complex government regulations governing coding may face audits by the Office of the Inspector General for HHS, Recovery Audit Contractors and Medicare Administrative Contractors, and the consequences of such audits can be severe.
Physicians and their staff now have a comprehensive guide available, which helps practices audit high-risk areas themselves, before payers get involved. Auditing Physician Services: Verifying Accuracy in Physician Services and E/M Coding To Protect Medical Practices, written by nationally-renowned coding and auditing expert Betsy Nicoletti, MS, CPC, offers critical information, support and plain-English explanations of how to avoid high-risk coding behavior.
Auditing Physician Services: Verifying Accuracy in Physician Services and E/M Coding To Protect Medical Practices provides clear, practical, concrete explanations of complicated coding issues and E/M guidelines, advice on auditing EMR notes, and a range of worksheets allowing physicians to conduct valid, defensible audits.
Auditing Physician Services: Verifying Accuracy in Physician Services and E/M Coding To Protect Medical Practices also includes a detailed analysis of the 2013 OIG Work Plan, which offers insight into how the agency selects physician practices for further review.
Table of Contents
- Medical practice compliance and the 2013 OIG Work Plan
- General principles of medical documentation
- Aberrant evaluation and management coding patterns
- How to audit evaluation and management services
- New patient visits
- Critical care services
- Billing for 99211
- Incident To billing and shared visits
- Use of modifier 25
- Billing for E/M services during the global period
- Initial preventive physical examinations and annual wellness visits
- Teaching physician rules
- Care plan oversight
BONUS: Auditing worksheets as you audit your practice. Worksheets are available for download at the book website in MS Word format so you can fill in the blanks!
Worksheets include the following:
Chapter 1: General principles of medical documentation audit sheets
- General principles of medical documentation; individual encounters
- General principles of medial documentation; medical record as a whole
Chapter 2: Aberrant E/M coding patterns audit sheet
- Aberrant evaluation and management coding patterns
Chapter 3: How to audit E/M services audit sheet
- E/M documentation auditing worksheet
Chapter 4: New patient visits audit sheet
Chapter 5: Consultations audit sheet
Chapter 6: Critical care services audit sheet
Chapter 7: Billing for 99211 audit sheet
Chapter 8: Incident to and shared visits audit sheets
- Incident to test (quiz and answer sheet)
- Incident to audit sheet for non-physician practitioner services; established patient visits
- Audit sheet for non-physician practitioner services; new patients
- Incident to audit sheet for nurse visits services
- Shared visit audit sheet
Chapter 9: Use of modifier 25 audit sheet
Chapter 10: Billing for E/M services during the global period audit sheet
- Use of modifier 57
- Use of modifier 24
- Use of modifiers 54 and 55
Chapter 11: Initial preventive physical examination and wellness visits audit sheets
- Initial preventive physical examination
- Annual wellness visit
Chapter 12: Teaching physician rules audit sheets
- Teaching physicians time-based codes audit sheet
- Teaching physicians primary care exception audit sheet
- Teaching physicians surgical services audit sheet; minor procedures
- Teaching physicians endoscopy audit sheet
- Teaching physicians surgical services audit sheet; major surgical procedures
- Teaching physicians E/M services audit sheet
Chapter 13: Care plan oversight audit sheet
About the Author
Betsy Nicoletti, MS, CPC, is president of Medical Practice Consulting, based in Vermont, and is the Founder of www.codapedia.com, a free website dedicated to coding and medical reimbursement. Betsy is a speaker on the national scene on coding, auditing and compliance and is a consultant and author. Her first book, The Field Guide to Physician Coding, 2nd Edition, is a best-seller. Besides doing auditing and compliance work, she excels at making complicated coding concepts easy for clinicians to understand and use. Betsy Nicoletti's mission is helping doctors get paid for the good work they do.
Every practicing physician will find this book the perfect resource for documentation and coding, just as I've found Betsy Nicoletti to be the perfect resource. Nicoletti puts complicated concepts into very practical terms. Keep the book close at hand for a chapter-by-chapter reference when questions arise.
Rosemarie Nelson, MS, MGMA Consultant
Betsy Nicoletti understands how physicians think. This is an excellent resource for physicians and
William Romer MD
MediSync, Cincinnati, OH
Working with Betsy Nicoletti for years, I know that you can rely on her advice regarding coding and auditing. She's a pro's pro!
Karen Zupko, President, Karen Zupko & Associates