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Medicare Compliance & Reimbursement

The 3 Deadly Myths That Could Be Hindering Your E/M Chart Audits

Published on Sun Sep 09, 2007

Experts advise you to focus on your evaluation and management visits to reap the biggest rewards from chart audits. But here are three myths that could hold back your E/M audits:

• All insurers audit using Medicare's guidelines. In fact, insurers may have their own criteria and you should be prepared for each payor's requirements, says Suzan Hvizdash, physician educator for the University of Pittsburgh Physicians Department of Surgery. Likewise, you shouldn't assume all insurers use the Marshfield Clinic's evaluation and management visit audit guidelines.

• You have to pick either the 1995 or 1997 guidelines to audit E/M charts, and stick to one. In fact, says Hvizdash, you can choose either the 1995 or 1997 guidelines for each visit, whichever is more advantageous.

• You can't use the same information for the history and Review of Systems (ROS). In fact, you're allowed to use the same information twice, as long as the physician documents it clearly, Hvizdash notes.

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