Arm against fraud risks EHRs pose, and develop policies to reinforce compliance. Electronic health records (EHRs) make documentation more legible, but they also make it easier to inflate content. Evaluation and management (E/M) documentation is especially prone to EHR shortcomings because of the repetitive nature of these services. Let’s consider the risks and resolutions. Authenticate ...
In Audit
Aug 1st, 2017
Effective June 23, the Centers for Medicare & Medicaid Services (CMS) changed its locum tenens policy, and expanded it to include physical therapists. Section 1842(b)(6)(D) of the Social Security Act allows payment for physician services provided by a physician other than the patient’s physician when the patient’s physician is unavailable. The policy covers both informal ...
Knowing the various entities reviewing your medical records for accuracy is half the battle. Any entity that is expected to pay your claims has the right to review the documentation that (hopefully) supports the services being billed. To prepare for the inevitable, you are wise to familiarize yourself with which entities may be interested in ...
In Audit
Aug 29th, 2015
By Charla Prillaman, CPCO, CPC, CPC-I, CCC, CEMC, CPMA When we audit medical claims for accurate coding, modifier usage is usually included in the findings.  Inaccurate or inappropriate application of modifiers to CPT© codes could result in inaccurate (over or under) payment of claims. Additionally, there are times when application of a modifier following CPT© ...
In Audit
Jun 30th, 2015
By Charla Prillaman, CPCO, CPC, CPC-I, CCC, CEMC, CPMA All pro-active medical practices perform coding/billing audits; some by practice staff and others by an outside vendor. These audits are usually designed to identify and, if necessary, remediate any gaps between medical record documentation and CPT, HCPCS II, and ICD-9 codes used for claims submission. Recent ...