In today’s coding environment, internal auditing is an important business process for avoiding costly repayments and other punitive measures for bad billing. Evaluation and Management (E/M) services are always highly monitored by auditors since those services represent such a large percentage of Medicare Part B billing.

What to know

Your internal auditors ought to be familiar with their provider’s E/M mix based on specialty and what the regional metrics are for other providers of the same specialty in their area.

What to do

If your providers are having problems with under coding or over coding of E/M services, White Plume Technologies can help. The AccelaSMART coding engine has the ability to review E/M levels to see if you are either under coding or over coding E/M procedures based on supporting diagnosis. Although White Plume applications are not documentation tools, they do have the ability to warn users when there are unlikely E/M levels selected for a particular diagnosis. Furthermore, AccelaSMART incorporates custom built rules unique to your circumstances, as well as the standard Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) in its encounter review to make sure you are not submitting claims with known coding errors. The White Plume applications allow quick, efficient and comprehensive evaluation for services so that you send out clean claims that can be paid the very first time they are submitted.