E/M Auditing Essentials: Improve Documentation and Decrease Improper Payments

Why Should You Attend:

Greater scrutiny from the OIG, government-contracted and third-party auditors make practice self-checks of physician E/M coding is more important than ever. CMS sees physician education and outreach as critical parts of an effective enforcement strategy and clarify policies when inconsistencies in billing practices arise.

The fiscal year (FY) 2017 Medicare FFS program improper payment rate is 9.51 percent, representing $36.21 billion in improper payments. “Best practices” in healthcare have an effective compliance plan in place that contains all seven elements. One of those elements is “auditing”.

This is an opportunity to look at your current process as well as obtain useful information on how to get started with an auditing program in your organization. Proactive review with auditing your claims prior to submission will increase revenues, decrease denials, rejects, and assist your organization in being compliant, so when you receive revenue – your will “get to keep it” because you are lower the chances of improper payment activities by implementing “best practice auditing essentials” the risks of being non-compliant with documentation and coding are too great.

Attend this webinar to enhance your understanding of level-of-service audits to improve audit proficiency by reducing risk and promote accurate claim submissions in your healthcare organization that may decrease improper payments.

Learning Objectives:
As a result of this training, attendees will:

• Understand how to implement and monitor an effective E/M audit plan
• Know how to tell an accurate patient story by aligning documentation to key components in the medical record
• Enhance skills in understanding the difference between Medical Decision-Making and Medical Necessity of the visit
• Identify areas of risk leading to E/M over or under coding and documentation
• Ensure that your coding practices are compliant with the regulations set forth by private and government payors
• Teach your providers and staff how to use documentation to maintain compliance and proper reimbursement

Areas Covered in the Webinar:

• Gain useful information and tools for understanding the E/M auditing process
• Increase your understanding of documentation requirements for the three key components - history, exam and medical decision-making.
• Take a proactive stance and learn to implement your own self-audit procedures. Conducting your own audits is considered “best practices.”
• Review the seven steps of an effective compliance plan.
• The benefits of establishing an effective chart audit process
• Step-by-step review of documentation requirements for ’95 vs. ’97 guidelines
• Guidance on selecting the level of medical decision-making
• Hands-on demonstration for aligning documentation to key components for “telling an accurate patient story”

Free Materials:

• Reference documents
• Rule documents or guidance
• Checklist
• SOP template
• Easy fill in forms
• Articles

Who Will Benefit:

• Medical billing and coding teams
• Auditors
• Medical Practice Managers/Administrators
• Physicians
• Clinical and practice staff involved in coding
• Compliance Officers/Committees
• Revenue Cycle Management Professionals

Pamela Joslin
Healthcare Consultant, Independent

Pamela Joslin has more than 20 years of medical practice management, billing and coding, auditing and compliance experience.

She is an engaging presenter via webinar, classroom and conference on every topic that may impact each step in the life of the revenue cycle of every practice.She has managed in medical practices ranging from single to multi-specialty groups, including ASC. She is an advocate of process improvement and maximizing and empowering employees to bring about the "best practice” results for your organization.

She received her Master’s in Management from University of Phoenix. Pam maintains memberships in professional organizations to support her continuing cycle of learning in the ever-changing healthcare industry.Pam is the owner and CEO of her medical consulting firm, Innovative Healthcare Consulting.

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