tci Medicare Compliance & Reimbursement - 2021 Issue Q4

Compliance: Improve Claims Auditing With Enhanced Communication

Tip: Boost E/M coding with a comprehensive review of documentation. Reviewing claims for medical necessity is a critical part of the in-house audit process. But your coders’ and auditors’ interpretation of medical necessity may diverge from that of your clinical staff, which is why solid documentation is vital to both auditing and claims success. “I’ve always taken the stance that medical necessity is really part of the audit. Medical necessity is not always about the service itself, but the documentation justifies the service,” says Terry Fletcher, BS, CPC, CCC, CEMC, SCP-CA, ACS-CA, CCS-P, CCS, CMSCS, CMCS...

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