Physicians with little enthusiasm for coding reviews of their practice become even less motivated when their perception is that the process does not always equate, due to a heavy managed care environment, to more income. This perception is not only unfounded, but dangerous. In fact, the higher the percentage of managed care billings, the greater the real need for a complete coding review. Not only can the process dramatically improve reimbursement and strengthen negotiating leverage, the practice also benefits by reducing the inherent risk of third party post-payment audits with properly priced, coded, and documented claim submissions.
Amidst today’s climate of zealous fraud and abuse enforcement, the reality is that a medical practice must undertake a coding review, if for no other reason than to provide peace of mind should OIG auditors come to call. That prospect is all the more likely when you consider the OIG is hiring more agents for audits on as many as one-third of all physician practices. E&M services are now better clinically defined, and the E&M Documentation Guidelines give Medicare and other payers the ability to reduce or deny payments through post-payment audits.