tci Part B Insider - 2019 Issue 4

Clip & Save: Review 5 Provider-Audit Hot Spots

Hint: E/M coding is a perennial Medicare claims audit favorite. Medicare Part B 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, during the webinar “Building a Risk-Based Audit Plan.” 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...

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