Physician E/M Coding: The OIG and RACs

Action Steps Necessary to Address Proper E/M Coding

Do you have enough knowledge of E/M codes? Or have you experienced a nerve-wracking experience in estimating if undercoding and overcoding occur with E/M Levels? If yes, no need to fret anymore. This power-packed session with Duane C. Abbey, Ph.D., will equip you with sufficient knowledge to handle such issues. In this live audio conference, you will get to know about the process of statistical extrapolation, if CPT guidelines apply to all third-party payers or not and how the RACs conduct audits for E/M coding.

The attendees will get answers to the following questions in this 90-minute session

• Why is there so much difficulty in selecting the proper levels?
• Does the ability of copying and pasting through electronic documentation impact the E/M level selection?
• What guidelines do physician have to follow?
• Why did the OIG find such a large error rate?
• How can improper E/M level coding generate billions of dollars in inappropriate payment?
• Will the RACs be interested in recouping improper payments for E/M Coding?
• Is statistical extrapolation complicated?
• What steps should physicians and clinics take to prepare?
• Should a mathematician or statistician be retained when statistical extrapolation is used?

Session objectives

• To understand the range and types of E/M codes with particular emphasis on sequences of E/M codes
• To appreciate the fundamental E/M coding requirements from CPT
• To review typical types of encounters that generate given levels of E/M codes as described in the CPT Manual
• To understand associated issues such as the ‘new’ vs. ‘established’ patients and the use of the “-25” modifier
• To assess the May 2014 OIG Report on the audits for proper E/M level coding
• To understand why there is such a large error rate found by the OIG
• To briefly review the CMS documentation guidelines from 1995 and 1997
• To appreciate why the RACs are most likely to have significant concern about auditing for proper E/M level coding
• To understand the statistical extrapolation process
• To appreciate the complexities involved with properly applying the statistical extrapolation process
• To review the action steps necessary to address proper E/M coding and to forestall the use of statistical extrapolation

Session agenda

• Introduction
  • • E/M Coding
    • Documentation guidelines
    • OIG study
    • RAC involvement
    • Statistical extrapolation
    • Copy and paste issues
• Physician E/M coding
  • • Review of E/M codes
    • Series of E/M levels
    • New vs. established patient
    • “-25” Modifier
• E/M coding guidelines
  • • CPT
    • Medicare 1995 guidelines
    • Medicare 1997 guidelines
    • Associated coding/documentation guidance
• OIG Report
  • • Audit from CY 2010
    • Improper E/M levels
    • Improper supporting documentation
    • Potential improper payments
• RACs and E/M levels
  • • Potential for RAC audits
    • Potentially large recoupments
    • Establishing audit protocols
    • What to watch
• Statistical extrapolation
  • • How does statistical extrapolation work?
    • RAC use of statistical extrapolation
    • Case Studies for E/M Level Coding
• Sources for additional information
• Case studies

Who should attend : All personnel involved with physician E/M level coding, billing, and reimbursementactivities. Compliance Officers, Compliance Analysts, Chargemaster Coordinators, Internal Auditors, other compliance personnel, financial analysts and other interested administrative personnel, coding staff, health information specialists, claims transaction personnel  and patient financial management personnel.  Non-physician practitioners and physicians are also encouraged to attend.

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