marsico
New
If you have a physician who is on 100% audit review for a previously failed E/M audit (less than 25% accuracy), do you assess any type of disciplinary measures (for lack of a better term) such as holding all charges including procedures until a marked improvement is seen in his coding? Do you make the physician responsible for reimbursing the Coding/Compliance Department for the additional coder resources required for the 100% review?
Along those same lines - what about one-level difference? We currently refund all differences whether one level or more. I have heard that some entities use a one level difference as an educational opportunity for the physician and do not refund the payor in that instance. The monies are only refunded when a 2 level difference or greater is identified.
I am looking for input to see if what we are currently doing is in line with others are doing.
Thanks,
MM
Along those same lines - what about one-level difference? We currently refund all differences whether one level or more. I have heard that some entities use a one level difference as an educational opportunity for the physician and do not refund the payor in that instance. The monies are only refunded when a 2 level difference or greater is identified.
I am looking for input to see if what we are currently doing is in line with others are doing.
Thanks,
MM