Auditing Yourself for E&M Compliance is a Must!

The most recent CMS E&M frequency data is posted, and it's worth your while to check it out. Go to KZA's E&M Frequency Data to and you will find that we have formatted the data by specialty for you.

According to Jennifer Bever, KZA consultant, “using the E&M data to benchmark your practice is the single best predictor of audit risk.” Profiling yourself to national and state patterns allows you to see where your coding stands out - positively or negatively. This technique is similar to how Medicare and commercial carriers decide who to audit, so if you take the time to benchmark yourself against the data, you'll know whether you may be a target.

Here’s how to do a comparison:

Step 1:

Run a CPT frequency report from your billing system and plot the results against the data for your specialty and state. If your end results do not approximate the benchmarks which often form a bell curve, then you have “profiled out” and may be at risk for an audit.

Step 2:

If your use of codes varies from the state data, your next stop is to check your documentation with a chart audit. Note that some sub specialists, or academic based practices, tend to be outliers. In other words, the otologist or neurosurgeon with a subspecialty or niche practice, who only sees patients with a physician referral or whose patients arrive with a stack of images, are likely to stand out from their colleagues. For instance, they often have more consultation codes than the CMS data. Sometimes their sicker patients warrant more level 4 than level 3 codes. None of this suggests that the doctors move to the state or national coding pattern - only that you need to make certain the documentation supports the coding. Ms. Bever notes; “just because you profile out doesn't necessarily mean your coding is wrong, but it does mean you run the risk of audit.” Remember, if your documentation is illegible, lacking and/or unclear, it doesn't count. Good intentions will get you nowhere. If you do not want to perform the audit, or do not have adequate resources, call (312) 642-5616 and we can help (KZA Consulting Services for Physician Practices.) If you find a consistent pattern of profiling out, run; don’t walk, to a specialty society coding course. Click here to find details about the KZA Coding & Reimbursement course for Orthopaedics, and Otolaryngology.

CCI Edit Corrections

If you begin seeing new denials on 2004 claims submitted to Medicare after January 30, 2004 that you did not see in early January, check the updated CCI edits closely. With the corrections to the CCI edits on January 30, Medicare may have additional edits that were not apparent January 1-30, 2004.

Is Your QuickBooks Version Up to Date?

Timely payment of bills is important to all practices - late bills lead to unnecessary interest payments and time consuming calls from creditors. Avoid both unpleasant issues - upgrade your outdated QuickBooks software today! To read more about the QuickBooks sunset visit http://support.quickbooks.intuit.com/support/DiscontinuationPlan.aspx.