There are numerous pre- and post-payment audits by the Centers for Medicare and Medicaid Services (CMS) each year. Built into the Medicare Integrity Program (MIP), these audits promote the integrity of CMS programs and the Children's Health Insurance Program (CHIP). Under MIP, both CMS and the Office of Inspector General (OIG) may conduct random audits, as well as audits that target suspicious or anomalous data. For cardiology practices, preparing now for these future audits keeps you proactive and ready should you be contacted to support your payments for E&M services.
In 2021 a great deal of risk stems from the implementation of new CPT® coding rules for Office and Other Outpatient E&M visits. This has spawned widespread confusion, not only about choosing codes that accurately reflect the level of service provided, but about how to support code assignments with physician documentation that precisely and completely captures the patient encounter in all of its complexities. Auditors are challenged when the record is not clear or detailed enough. If a provider states three chronic conditions in the HPI and also lists a new onset of lower extremity edema, can you add those together to go from a moderate to high patient presentation of problems addressed under MDM? Or, if the physician documents ordering several tests, reviewing labs, and speaking to an external provider on behalf of the patient, can you count them separately when leveling an E&M service under the Data Points (MDM) under new guidelines or do you only get credit for one point collectively for tests ordered/reviewed? To ensure accuracies in your reimbursement, your documentation, reporting and coding practices, you must have a firm understanding of the correct answers to these and other crucial questions.
Ensure full compliance and supported payments by joining us for this ICD10monitor webcast, presented by nationally recognized healthcare professional coding and reimbursement consultant, educator and auditor Terry Fletcher. Ms. Fletcher will walk you through key elements of auditing your records, pertaining to 2021 E&M Guidelines for Office and Other Outpatient visits (CPT codes 99205-99215) — and specifically addressing cardiology and peripheral vascular services. From her presentation, supplemented by real-life E&M examples, you'll take away proven strategies, along with tips and tools to help you protect a major revenue source.
Why This is Relevant:
Cardiology practices are among the top billers of E&M services — which also makes them prime audit targets by Medicare and other payers. Here's the kicker: Their auditors have been remarkably successful at extracting sizable refunds from providers. Conversely, you may be missing out on significant revenues — including an 18% average increase in RVUs for 2021 — due to erroneous reporting. Securing the maximum legal payment starts with understanding how you should be leveling your services, based on time or new medical decision-making (MDM) criteria. With guidance from this webcast, you will be empowered to keep your documentation and coding compliant and accurate.
- How to audit both time-based and MDM-based E&M encounters, specific to cardiology practices, for new and established patients
- When it's appropriate to use the new prolonged service code(s) with a level 5 encounter
- Insights into the use of EMR macros and templates pertaining to cardiology/peripheral vascular E&M encounters
- Hands-on auditing skills acquired through an interactive exercise involving a cardiology practice encounter
- Answers to your questions during a dedicated Q&A segment
- Ultimately, improve your ability to pass an audit for cardiology/peripheral vascular E&M encounters in the office and other outpatient settings
Note: Attendees will receive materials prior to the session, including professional association audit tools and specialty encounter documentation for the interactive exercise.
Who Should Attend:
Physicians, non-physician/advanced practitioner professionals, medical providers, coders, billing and collections staff, practice administrators, compliance staff, clinical documentation integrity auditors and payers.
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Webcast Access Privileges: Only one login is allowed per webcast purchased. Discounted pricing for additional registrants is available. For more information about webcast pricing and requirements, click here.