E&M Documentation: Train the Trainer

Event Information
Product Format
Prerecorded Event
Presenter(s)
Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow
Length
90 minutes
Product Description

Get Expert Help in Making Sense of Medical Necessity, E/M Documentation and EHR Issues

 

Did you know that if your EHR is producing E/M documentation that is robust in one section (such as History) and thin in another (such as the Physical Examination), you may be trusting the device to do too much?

Auditors can down-code most of your E/M claims due to an empty “Physical Exam” section in the documentation. However, some practices argue that the EHR vendor told them that patients being seen for established problems already have a physical examination documentation on file, and that the EHR will carry it over from one visit to the next. In reality, this may be true for past medical, family, and social history (PMFSH), but not for a physical examination.

Correct documentation and coding for E/M services is one of the most misunderstood requirements placed on a physician. The risk is that making documentation and/or coding mistakes means that you’re putting your practice at risk for major compliance violations. Your practice could lose precious revenue. Plus, the EHRs that offer coding or coding recommendations can confuse you and lead to costly errors. Join our expert speaker, Barbara J. Cobuzzi, to navigate through the dangers of E/M services and avoid potential disasters along the way.

At the end of this session, you’ll have all the definitions you need to know. You will be able to fit all the many E/M working pieces together and be able to present this in a way that makes sense to your physicians. With this information in hand, you will bring medical necessity, E/M documentation and EHR issues all together.

Highlights of the session:

  • How Do Physicians Get Selected for Audit?
  • Medical Chart NCQA Guidelines
  • Documentation Guidelines & Medical Decision Making 
  • Consultation vs Concurrent Care
  • Documentation for Non Physician Practitioners
  • Documentation Requirements & Pre-Operative Clearance for Non-Medicare
  • Error Rate for Incident-to Services Performed by NPP & Place of Service Issues
  • How to document an ABN?
  • How do you teach E/M to your providers?
  • What should you look for once an EHR has been implemented?
  • What actions need to be taken to protect the practice for both compliance and income optimization?
  • Educating the providers to enable them to care for patients and not be overwhelmed by E/M calculations.
  • OIG recent report on high level E/M services, Top Physician Audit Targets & E/M Risk Areas.
  • Incident to Errors & “Incident-to” Basic Requirements.

Components of E/M Services

  • Category & Subcategory
  • Medical Necessity
  • Nature of Presenting Problem
  • History Level
  • Review of System
  • Past, Family and Social History
  • Special Circumstances

Who should attend?

Physicians, Office Managers/administrators, Coders, Billers, Billing Managers/Supervisors, EHR implementation teams

Order Below or Call 1-866-458-2965 Today

You can also order through:

1-866-458-2965

1-919-287-2643

About Our Speaker

Barbara J. Cobuzzi - Healthcare Compliance Training Expert

Barbara J. Cobuzzi is owns CRN Healthcare Solutions where provides value added provider consulting services.  She holds a BS in Industrial Engineering from Rensselaer Polytechnic Institute and an MBA from New York University.  She holds certifications from the AAPC as a CPC (certified physician coder), COC (certified hospital outpatient coder), CPC-P (certified payer coder) a CPC-I (certified coding instructor) and a CPCO (certified professional compliance officer).  She also...   More Info
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