tci Medicare Compliance & Reimbursement - 2019 Issue 3

Put These 5 Focus Areas On Your Audit Radar

E/M coding remains a hot issue for Medicare claims auditors. Medicare coders should get to know five main areas involved in provider audits: 1. E/M Codes: Everyone is interested in audits of E/M codes, noted Frank D. Cohen, director of analytics and business intelligence with Doctors Management, LLC. Although E/M codes make up 1 percent of all procedure codes, they comprise about 18 to 20 percent of all volume and about 26 percent of the total paid claim amount. “I’ve done 400 to 500 post audit extrapolation cases throughout my career, and I can tell you that...

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