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Use these tips and tools to tackle physician audits

Health Care Auditing Strategies, April 1, 2008

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Regular auditing and analysis of physicians' evaluation and management (E/M) coding and documentation needs to be high on your agenda, especially given recent OIG crackdowns and the increased use of recovery audit contractors.

By focusing your limited resources on a few high-risk areas, based on reimbursement, you can easily manage audits, lower risk, and generate valuable benchmark -data, said Andrei Constantino, MHA, CHC, CPC-H, CPC, director of organizational integrity at Trinity Health in Farmington Hills, MI.

In a March 5 audioconference, Constantino and -Margaret Nusbaum, BA, CPC, Trinity Health's senior organizational integrity specialist, explained how they narrowed the field of E/M codes based on Comprehensive Error Rate Testing data from CMS and used those data to subsequently create an audit tool and physician scorecard.

They determined that a few E/M services account for the lion's share (70%-80%) of net revenue, explained Nusbaum. For example, codes 99214, 99232, 99233, and 99213 are some of the most commonly submitted codes, and therefore, outliers in these areas will likely be targets for government scrutiny.

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