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ED Coding and Reimbursement Alert

Compliance:

How Will Recent Media Hype On EHRs And Upcoding Impact Your Compliance Plans?

Published on Wed Nov 14, 2012

Get the facts on whether and why your ED E/M frequency distributions are shifting to the right and higher acuity to be ready for any audits. You likely heard a lot of public discourse about the ED Evaluation and Management (E/M) codes in 2012. Read on for a summary of the issues and expert advice on how to react.First, in May 2012, the HHS OIG issued a report citing that ED E/M's were the fifth largest paying codes in Medicare among all of the E/M codes, says Ed Gaines, JD, CCP Chief Compliance Officer for Medical Management Professionals, Inc, in Greensboro, NC. While acknowledging that it had not performed chart or medical record reviews of the documentation and coding, the OIG noted that from 2001-2010 CPT® code 99285 increased from 27% to 48% in the ED E/M frequency distribution, says Gaines. Put another way: With each percentage or fractional point [...]
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