Incorporate the consult changes into your compliance program

As of Jan. 1, 2010, you haven’t been able to bill Medicare for office and inpatient consults. Auditors are already watching the E/M services physicians have billed instead and they expect to find mistakes. When you conduct an internal review of your E/M claims, you need to know the warning signs that signal upcoding, insufficient documentation or lack of medical necessity before a payer’s audit department finds it and demands a refund.

Don’t waste time worrying that you’re racking up overpayments or wondering if you’re passing up payments you’re legally due. Compliance expert Dianne Wilkinson, RHIT will show you how to conduct an internal review your claims that will root out trouble spots before they grow into huge over (or under) payments.

Learn the red flags that signal your E/M billing is heading off the rails:

  1. New vs. established patient errors. Make sure you’re following Medicare’s rules because auditors are already looking for mistakes.
  2. Documentation didn’t drive code selection. Find out what you must see in your doctor’s documentation to be certain it supports the level of service billed.
  3. Medical necessity mistakes. Learn four easy ways to spot and eliminate common medical necessity errors that could trigger an overpayment demand.
  4. Initial and subsequent inpatient visits. Inpatient visits are already on your carrier’s radar. Find out how to spot and prevent the mistakes auditors are looking for.
  5. Observation or admission? Don’t let confusion over these two services lead to costly billing mistakes.
  6. Modifier AI errors. Find out where and when you should see this modifier on the doctor’s claims.

Bonus: Private payer consults policies – the rules have changed. Make sure the consults you can bill don’t spark overpayments.

Registration Details