Medicare Compliance & Reimbursement

Top tip: Medical necessity should drive your practice's claims. Conducting regular self-audits ensures that your physicians are documenting evaluation and management services properly and the coding and billing systems in your practice are compliant. Three documentation Q&As can guide you to improved claims results. Background: When you audit your practitioner's services, you can uncover incorrect coding patterns or compliance issues. You'll discover any problems before an outside auditor (such as a RAC or an OIG auditor) does, and you'll be on your way to collecting the exact reimbursement you should. Get Into the Habit of Documenting Time Spent Question 1: After completing our audit, we found several instances when the doctor billed 99214 and the documentation did not warrant it. However, in all of these cases, he spent 30 minutes with these patients (who had multiple chronic issues), almost all of which was spent counseling them and coordinating their care [...]