Auditing/Compliance Tips & Resources


Reserve 99205 for the Sickest Patients

Level 5, new patient evaluation and management (E/M) code 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity...

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Decode Documentation to Code Fractures

The first three digits of a fracture diagnosis (ICD-9-CM) code describe the fracture location. For instance, codes series 800.xx-804.xx describes fractures of the skull, while code series 820.xx-829.xx describes fractures of the lower limbs...

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Routinely Waiving Copays May Be Fraud

In a healthcare environment where every penny is scrutinized, it’s hard to believe some practices waive copays completely, or offer “insurance-only” payments. If you’ve been known to let copays “slide,” and don’t follow up with letters requesting patient payment, you could be bringing on trouble...

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