scrutinizing physician e/m services. according to the contractor’s website, it is performing “statistical sampling on evaluation and management claims to calculate and project incorrectly paid claims” (issue number c000912012). the contractor will look at dates of service going back to october 1, 2007.5 the decision to initiate this type of review was based on a year-long examination of approximately 362 million claims by the center for Public integrity.6 the center analyzed claims from “a representative 5 percent sample” of medicare patients beginning in 2001. according to the center: the cost analysis projected the increase in medicare costs as more doctors picked higher codes each year over the decade. the added fees totaled at least $11 billion, adjusted for inflation—more than half of it from higher doctor fees for office visits and the rest from other services, including treatment in nursing homes and hospitals. in addition, although some physicians state that their patient demographics have changed, with older and sometimes sicker patients, many healthcare experts say that the age and health of medicare beneficiaries as a group has not changed.7 meticulous medical record documentation has always been 44 hbma billing • march.aPril.2013 one of the keystones of quality patient care. a complete, accurate medical record has the capacity to protect providers in multiple scenarios, not the least of which is claim audits. cms is likely to expand this audit to the entire nation, so it is important that you discuss this critical issue with your clients before they find themselves embroiled in an audit. encourage, or assist, your clients to perform an internal audit of patient visit services. specifically the following items should be reviewed: • legibility of handwritten entries • Physician signature/authentication • indeterminate authorship (ability to distinguish staff notes from physician notes, including non-physician practitioners) • review of systems (ros) for completeness • time used as key component, but not adequately documented • correct application of modifier 25 (significant, separate service) • medical necessity for extent of examination the office of inspector general (oig) recommends that practice audits be conducted at least annually and that they HQAA has specically designed an accreditation program for third-party billing organizations. Our web-based tools and personal accreditation coaches are designed to help you run leaner and meaner. So you can earn more trust. And gain more business. Congratulations, HBMA, on your 20th anniversary. See you at the spring conference, booth #222. 866.909.4722 www.HQAA.org/billing (E/M Services Under the Gun continued)
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