The Centers for Medicare and Medicaid Services (CMS) conduct numerous pre- and post-payment audits every 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 Office of Inspector General (OIG) may conduct random audits, as well as audits that target suspicious or anomalous data. For orthopedic practices, preparing now for these future audits keeps you proactive and prepared should you be contacted to defend 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. For example, multiple conditions and comorbidities, such as knee pain, swelling and stiffness, are commonly encountered with orthopedic patients, but can you count them separately when leveling an E&M service under the new guidelines for medical decision-making (MDM)? To support your payments, you must have a firm grip on the correct answers to this 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 general and spinal orthopedic 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:
Orthopedic 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 MDM criteria. With guidance from this webcast, you'll 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 orthopedic 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 general and spinal orthopedic E&M encounters
- Hands-on auditing skills acquired through an interactive exercise involving an orthopedic practice encounter
- Answers to your questions during a dedicated Q&A segment
- Ultimately, improve your ability to pass an audit for general and spinal orthopedic 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.
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.
CPT® is a registered trademark of the American Medical Association.