Evaluation and Management (E/M) services have many gray areas from an auditing standpoint, yet they continue to represent a top audit target for payers and the government.
The documentation guidelines for E/M services are now 20 years old and have seen no significant changes. What has changed, however, is how the medical record is created, analyzed, and scored.
What we have been left with are guidelines that are suggestive in nature and leave many areas open for interpretation by medical auditors across the industry. Auditors themselves differ widely in experience and training, which affects how they interpret the guidelines. The interpretation of these areas may vary widely based on the experiences and training of the auditor. In our recent National Alliance of Medical Auditing Specialists (NAMAS) salary survey, we found that 64 percent of respondents had been performing audits for less than five years. Of these respondents, 50 percent had been performing audits for less than two years. Many of these auditors have no formal training and rely on instructions they were given about the guidelines during on-the-job training that can vary widely in quality.
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