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

by Betsy Nicoletti

Overview

Auditing Physician Services: Verifying Accuracy in Physician Services and E/M Coding to Protect Medical Practices, 3rd edition

 

by Betsy Nicoletti, MS, CPC

 

Take the steps to audit your practice...before the Government or Third-Party Payer does!

New for the 3rd Edition - Overall updating of all chapters PLUS:

• 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

The key topics covered include a welcome amount of in-depth coding information -- topics and activities that practices perform every week.

 

Protect your practice from governmental and third-party payer audits! This 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: Verifying Accuracy in Physicians Services and E/M Coding To Protect Medical Practices, written by nationally-renowned coding and auditing expert Betsy Nicoletti, MS, CPC, offers critical information, support and plain-English explanations of how to avoid high-risk coding behavior.

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 a detailed analysis of the OIG Work Plan which offers insight into how the agency selects physician practices for further review.
 

Product Details

ISBN-13:	9780998498577
Publisher:	American Association for Physician Leadership
Publication date:	04/01/2018
Sold by:	Barnes & Noble
Format:	eBook
Pages:	222
File size:	18 MB
Note:	This product may take a few minutes to download.

About the Author

Betsy Nicoletti, MS, CPC, has extensive auditing experience in physician services, ensuring that code selection accurately reflects the services performed. Joking that she is in the "protection" business, Betsy explains that her mission is to simplify complex coding and reimbursement rules for medical practices, thereby "protecting" physician practices. She is the author of The Field Guide to Physician Coding, now in its third edition, and Everyday Medical Coding, as well as a regular journal contributor. Betsy also speaks to groups on the national scene. When speaking to clinicians, she engages them with an in-depth knowledge of their professional lives. When speaking to fellow auditors, she guides them through the nuances of finding black and white answers in a morass of gray guidelines. Betsy, who began her consulting business in 1999, has a master's degree in Organization and Management from Antioch New England and is a Certified Professional Coder. She is a member of the Medical Group Management Association and the National Speakers Association. She lives in New England with her dog. Betsy can be reached at www.betsynicoletti.com. You can read her blog at www.nicolettinotes.com.

Table of Contents

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

• Chapter9: 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