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 coding for the office and outpatient hospital settings has been totally revamped for 2021. Conducting your own E/M coding audits for these changes 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

E/M Auditing is an essential tool to ensure success and E/M compliance for 2021. 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.

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