Medicare Compliance & Reimbursement

The responsibility is on your practice to ensure that you're reporting the right codes. Your electronic health record (EHR) may make your job easier, but it won't make your claims entirely "audit-proof." Case in point: A practice recently noted that one of its new physicians has been billing almost all 99215s for his E/M visits, which the EHR calculates based on the information that the physician enters into it. The practice manager pointed out that the vendor who sold her the EHR told her that its E/M calculator was auditproof, so she had been submitting the 99215s without checking the documentation. But she recently reviewed a claim and realized that the physician was sometimes examining body systems that weren't medically necessary for the condition, making his codes automatically register for higher levels than the patients' diagnoses warranted. This habit could become problematic for this medical practice. "In addition to needing [...]