Auditing Physician Services: Verifying Accuracy in Physician Services and E/M Coding to Protect Medical Practices Third Edition

Protect your practice from governmental and third-party payer audits. New! Auditing non-face-to-face prolonged services--now covered by Medicare Updates to TCM and CCM based on new CMS rules including the initiation visit before CCM New! HCPCS codes for Collaborative Care Model and Behavioral Health Initiative New! HCPCS code for cognitive assessment BONUS! Download 28 Audit Worksheets to use again and again! This THIRD EDITION of the BEST SELLING BOOK explains complex reimbursement and coding rules and provides audit sheets for key, high-risk areas including E/M services. Today, medical practices face major risks if they don't code physician services accurately. Practices that violate the complex government regulations governing coding may face audits by the Office of the Inspector General for HHS, Recovery Audit Contractors and Medicare Administrative Contractors, and the consequences of such audits can be severe. However, physicians and their staff now have a comprehensive guide available which helps practices audit high risk areas themselves, before payers get involved. Auditing Physician Services, provides clear, practical, concrete explanations of complicated coding issues and E/M guidelines, advice on auditing EMR notes, and a range of worksheets allowing physicians to conduct valid, defensible audits. The book also includes an analysis of the OIG Work Plan which offers insight into how the agency selects physician practices for further review. Table of Contents Medical Practice Compliance and the OIG Work Plan Chapter 1: General Principles of Medical Documentation Chapter 2: Aberrant Evaluation and Management Coding Patterns Chapter 3: How to Audit Evaluation and Management Services Chapter 4: New Patient Visits Chapter 5: Consultations Chapter 6: Critical Care Services Chapter 7: Billing for 99211 Chapter 8: Incident To Billing and Shared Visits Chapter 9: Use of Modifier25 Chapter 10: Billing for E/M Services During the Global Period Chapter 11: Initial Preventive Physical Examinations and Annual Wellness Visits Chapter 12: Teaching Physician Rules Chapter 13: Behavioral Health Services in Primary Care Practices Chapter 14: Transitional Care Management (TCM) and Chronic Care Management (CCM) Final Thoughts Appendix 1: E/M Documentation Auditing Worksheet Index BONUS: Auditing Worksheets as you Audit Your Practice. Worksheets are available for download at the Nicoletti book website in Word Format so you can fill in the blanks! Read more