tci Medicare Compliance & Reimbursement - 2016 Issue 9

Replace Poorly Scribbled Notes with Technology

Tip: Focus on your patients, not your notes. If you repeatedly face downcoded or denied E/M claims, your documentation may be to blame, says Lee Peter Bee, DO, DC MS, FACOI, a solo practitioner with Southern Illinois Medical Specialists in Sesser, Ill. You need strong documentation of exactly what you did and how long you spent with the patient, which hasty scribbling rarely presents. Apart from coders and billers being unable to read illegible writing, you also stand to have your attention diverted from your patients if you are writing or typing notes during the exam. This is where...

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