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2021 E/M Guidelines: Case Study & Audit Findings

Case Study

Since the implementation of the 2021 E/M guidelines for outpatient office visit services, it’s time to see how the new changes impacted accuracy and reimbursement. Here we review the data collected from a large hospital system (6,000+ physicians in all specialties).Prior to performing three audits spanning July 2020-July 2021, we provided rigorousclinical documentation training — based on the 2021 requirements —to physicians and other non-physician providers.Discover whether the E/M level remained the same, went up, or went down — the results are in the case study.  

Plus, we look data from thousands of chart reviews we performed, focusing on utilization and accuracy of codes 99202-99205 billed by the provider or coder. We pulled archived data from CMS, employed AAPC’s E/M Benchmarking Tool, and looked at dates of service from 2019-2020, then focused on 2021 separately. This information is also found in the case study. 

About the author

Stephani Scott

Stephani Scott has over 30 years of experience in the healthcare industry working closely with physicians and staff in Health Information Management. She has worked in a variety of settings including hospitals, long-term care, large multispecialty physician practice, and EHR software design and development. Scott was a part owner of a consulting company for many years providing services in best practices for physician practice management services including coding and documentation audits, compliance, and revenue cycle management. She has extensive experience in inpatient and outpatient auditing and coding compliance. Throughout her career, Scott has enjoyed teaching E/M coding, compliance, and EMR utilization to many physicians and staff locally and nationally.

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