Health Information Management

Tip: Correctly structure an E/M audit

APCs Insider, December 30, 2011

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After completing a risk analysis, a facility or practice should develop an audit structure that will work best in its specific setting.
 

An audit structure consists of three basic elements:

  • Objective, which is the audit’s goal, such as ensuring providers bill the appropriate evaluation and management (E/M) level.
  • Scope, which is the type of audit, the data the auditors will examine, and the number of records they will review
  • Level of risk, which is the impact the audit will have on the organization. Conduct a high-level sample review to gain a general understanding of how providers document and bill for services.

This tip was adapted from Auditing Evaluation and Management Services, A Step-By-Step Guide to Accurate Coding, Reimbursement, and Compliance, Second Edition. For more information or to order a copy of the book, visit HCPro’s Healthcare Marketplace.



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