E/M Auditing: A Step-By-Step Guide to Updated Coding, Reimbursement, and Compliance

Joe Rivet, Esq, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO

Turn E/M audits into informative reports that minimize your compliance risk and identify potential revenue losses.

E/M Auditing is an essential tool to ensure success and E/M compliance. This book goes beyond the fundamentals of E/M coding and delves into the gray, problematic compliance areas.

Author Joe Rivet, former coder now attorney and E/M expert, delivers step-by-step guidance from beginning to end of the E/M audit process. You’ll learn how to select an updated E/M code, conduct an entire audit of your E/M services, and report your E/M audit findings.

Conducting your own E/M coding audits is best practice to effectively:

• Analyze complex code assignment options to select the appropriate code
• Assign an appropriate E/M code based on documentation in the record
• Identify opportunities for increased revenue and ways to reduce compliance risks
• Understand the rules and regulations that apply to E/M services billed to Medicare
• Assess medical necessity and the interplay of nature of presenting problems

With this foundation, you’ll be well prepared to enhance compliance and identify undercoding, underreporting, overcoding, revenue opportunities, and avenues for documentation improvement.

E/M Auditing will help practices enhance existing auditing programs by explaining how to determine accurate E/M error rates and assess risk.

You will learn how to:

• Determine proper E/M code selection
• Conduct risk assessments
• Structure and package audits
• Use the new E/M guidelines under the new medical-decision-making criteria
• Create provider audit summary reports, practice audit summary reports, missed revenue reports, and an action plan
• Follow guidelines for facility E/M services and interpret the rules governing E/M services involving residents or fellows (including acceptable and unacceptable documentation and student documentation)
• Develop a compliance plan and educate a variety of audiences from physicians to coding staff
• Look at overall medical necessity when assigning E/M levels

Who will benefit from this book?

• Auditors and compliance officers in physician practices and hospitals
• Health systems that own physician practices
• Business managers
• Office managers
• Practice administrators
• Coding, billing, and reimbursement managers and staff
• Reimbursement and healthcare attorneys

Also includes a laminated, pop-out card featuring the American Medical Association’s Medical Decision Making table!

Published: January 2021

Pages: 122
Format: 8.5 x 11 perfect bound
ISBN: 978-1-64535-095-8