“Finally Friday!” Ambulatory Self Audits & Odd ALJ Errors in Law

FRIDAY April 24, 2015:

Ambulatory Self Audits:

Common Codes, Common Errors?

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Actually, you have more options than this, but your EMR is probably not as smart as you might imagine.

Actually, you have more options than this, but your EMR is probably not as smart as you might imagine.

Two of the most commonly used codes on Part B claims are 99213 and 99214. This makes them rather routine… which all by itself makes them vulnerable to errors, since humans do sometimes simply make errors, especially while performing routine or repetitive tasks. Indeed, over the years, CMS’ Combined Error Rate Test (CERT) studies report continued high error rates for claims, most notably a high error rate where documentation in the medical record was not found to support the medical necessity of the billed service or procedure.

Dr. Pahuja has been speaking and helping hospitals teach physician documentation for several years, at his company Aerolib.

Dr. Pahuja has been speaking and helping hospitals teach physician documentation for several years, at his company Aerolib.

While these E&M codes are not high paying by the claim, the sheer volume of these claims, even for a single physician, can add up quickly. National statistics project that perhaps as much as $40,000 per year may typically be at risk due to poor or lack of documentation to support medical necessity. For a hospital or clinic with 100 physicians, that’s a cool $4 million. Something worth looking into, don’t you think?

Deepak Pahuja, MD MBA FACP and Chief Medical Officer at Aerolib Healthcare Solutions, LLC, joins us this week to report on some findings at one of his client facilities. With a random sample of cases, conducting an analysis with 44 variables, he’ll tell us his surprising results, and discuss what you can do to perform the same kind of analysis.

Dr. Pahuja will reveal:

  • claims/codes to consider for analysis,
  • variables to consider for analysis,
  • the top ten findings of his analysis,
  • two surprising but common issues, and
  • what you can do to perform your own analyses.

Of course, you can always contact Dr. Pahuja and discuss it with him, yourself!

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