tci Medicare Compliance & Reimbursement - 2005 Issue 12

Enforcement Watch: Get MDM Descriptors From Providers Before Audit

Physician practices' MDM levels will be in auditor's crosshairs.When Medicare sends auditors to look at evaluation and management claims, they're going to zero in on doctors' medical decision making, experts say.Auditors aren't scrutinizing the exam or history as much - "they definitely weight [the audit] toward medical decision-making," says Lori-Lynne Webb, director of coding and compliance with Saltzer Medical Group in Nampa, ID. The problem is that even if you're a physician keeps spotless records of history and exam, the practice could wind up downcoding or facing audits if the medical decision making doesn't tell a...

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