BC Advantage - 2023 Issue 3

Choosing the Right Tool: Targeted vs. Random E/M Audits

The realm of E/M (evaluation and management) auditing is vast, and 2023 will bring more work here than before thanks to CPT's extensive revisions to its E/M guidelines for inpatient, facility, and home visit services - now in effect. Both compliance professionals and providers must always keep in mind that E/M services (which account for a third of annual Medicare Part spending) will go from being a perennial easy target to an urgent area of attention in 2023. For healthcare payers, the new changes represent an undiscovered country of shifting utilization patterns and potential overpayments, just waiting to be...

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