Six Steps for Conducting an Internal Evaluation & Management Audit

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Sarah Wiskerchen, MBA, CPC

Six Steps for Conducting an Internal Evaluation & Management Audit
Healio Orthopedics • Orthopedics Today – September 2017

by Sarah Wiskerchen, MBA, CPC

Evaluation and management coding patterns are under the microscope. CMS is monitoring evaluation and management code usage by specialty, state and nationally. The Recovery Audit Program of CMS aims to identify and correct improper Medicare payments through the detection and collection of overpayments. Commercial payers are using analytics to identify potentially inaccurate coding, too; take-backs may result.

An annual review of each provider’s evaluation and management (E/M) code usage is essential to effectively manage the audit risk of your practice. The process of reviewing documentation identifies coding pattern or usage anomalies — possible non-compliance. This, in turn, uncovers opportunities for educating physicians and staff on how to properly document, code and bill for services according to federal, state and payer guidelines.

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