Keeping Up With the Jones - OIG Examines E&M Trends

May 18th, 2012

The Officer of Inspector General recently published a report entitled "Coding Trends of Medicare Evaluation and Managment Services."

Yes, it's great reading for the insomniac; and perfect to put on the table at a sleep lab.

But it's also full of insights that will help you!

For example, every specialities' bell curve has shifted to the right between 2001 and 2010 in all visit types..  That means, providers are charging higher levels of service than they did in 2001.

Per the OIG report: "E/M services have been vulnerable to fraud and abuse."  On page 9 of the report, which may be found at http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf, a graph shows that office established office visits 99211 through 99213 all declined in percentage of frequency.  99214 and 99215 both increased.  99214 increased an astounding fifteen percent. (15%).

Similar trends are apparent in other types of E/M service billing.

As a result of this study, OIG turned the names of 1,700 physicians over to CMS and suggested review.

Bottom line:  when keeping up with other providers' billing patterns, be sure that you have both the medical necessity and the medical documentation to support your coding. 

Tags: OIG, Evaluation and Management

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