Wiki E/M Auditing

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Ronilynn

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One of the things that frequently needs to be audited at our office is the level of office visit our providers bill in our Urgent Care. I am now reponsible for this auditing but really have no "formal" training. Is there something out there that someone uses that helps clarify this process for me? I'm kind of being thrown to the wolves with this and could really use some help! Thank you!
Rhonda
 
Hi Ronilynn,
There is an auditing subforum that might be more helpful for you. There is a ton of information available online. You should look for an E/M auditing tool that can usually be provided on the website for your local MAC. Who is your MAC, or what state are you in?
 
Ok, so the Medicare carrier for your state is Noridian Healthcare Solutions. Their website doesn't offer any Evaluation and Management audit tools, just general 'documentation checklists' that give a general idea for what should be in the note. They do refer to the 1995 and 1997 documentation guidelines. It would be a good idea for you to print out both of those for your reference.

If you are looking for an audit tool, I can recommend this one. Just keep in mind that this is the audit tool that my local Medicare carrier uses, and since your carrier doesn't appear to have anything published, they might say their definitions are different. For example NHIC considers an exam of 5 organ systems to be a detailed exam. It's possible that Noridian may consider it to be expanded problem focused. Still, this tool is a good place to start until you feel comfortable with scoring the level of history, physical examination, and medical decision making complexity.

Once you familiarize yourself with the 1995 and 1997 documentation guidelines, you should be able to audit the notes for your own office, and you will get better with experience. Feel free to ask the provider for clarification if you are unsure of what a term or acronym or eponym means.
 
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