2021 E/M Guidelines: Case Study & Audit Findings

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.