Practice Management Alert

Auditing downcoded evaluation and management claims can be a great way to ensure success on appeal. You can design an auditing tool that will work best for you, but here's a sample cover sheet you can use to summarize your findings for reviewers. (Source: Erica Schwalm, compliance officer and reimbursement specialist, Pioneer Spine & Sports Physicians, West Springfield, MA.)

Patient Name: _______________________________  MR# ________________
Examined by: _______________________________  DOS: ________________
Service Type: _______________________________
Insurance: __________________________________  POL# ________________

CPT CODE BILLED: ________________________

History Level:
Exam Level:
Decision-Making:
Time:
Length of visit:
Amt. of time counseling and/or coordinating care:

CPT CODE SUPPORTED: ________________
(See attached for specifics of Hx, Exam & MDM)

Additional comments:____________________________________________________________
______________________________________________________________________________

Audited by: ______________________   Date: __________________