Protect your revenue and doctors with a proven workflow tool for chart auditing If you think the IRS is the only government agency that’s engaged in aggressive auditing, think again. No fewer than FIVE separate federal entities have your E/M services in their sights, and CMS has said that audits of all types will increase “in depth and breadth” after ICD-10 hits in 2014. To avoid giving money back, or worse, you need workflow tools that can perform quick, accurate and consistent internal audits so you know if your services are at risk. View this recorded webinar to learn how E/M ProCheck, a top-selling chart auditing tool, can give you critical early warning of audit risk immediately, while also improving provider coding in the long term. Discover how E/M ProCheck lets you check your providers’ coding against local peers of the same specialty for any unusual patterns – the same technique used by OIG and RAC auditors. You’ll also see how quickly E/M ProCheck can perform chart audits with its simple, web-based click-and-point interface. To request more information about E/M ProCheck or to receive a custom demonstration, call 1-855-225-5341 today! Mention code EMPA1304.

1. 1
E/M Audit Tool Efficiencies

2. Grant served as editor for the industry-leading
physician practice reimbursement and
management newsletter, Part B News, for
five years, covering Medicare payment policy,
fee schedules, compliance rules, and coding
and billing best practices.
Your presenter
Grant Huang
Product manager

3. E/M services are easy targets
• Easy to audit
• High-volume services as they are the single largest service type billed by
providers, regardless of specialty
• Generate a lot of money for the carriers and other groups that perform audits
• Easy to claim overpayments on because of the high level of subjectivity
• An attractive target in an environment where healthcare spending is too high
and CMS, HHS and the OIG face significant political pressure to reduce
“fraud, waste and abuse”

4. E/M levels are creeping up
Possible causes:
• Automated templates suggesting higher selection as EHR adoption skyrockets
• Providers feel more confident in choosing higher levels/feel the pinch from declining
payments overall
• Growth in volume of complex patient cases with multiple ongoing chronic conditions (aka
“we’re all getting sicker”)

5. 2013: Audits are a massive federal money-maker
• For every $1 the government spends on audits, nearly $8 are recouped from
providers
• Given federal deficits and rising healthcare costs, a major expansion in the scale,
frequency and intensity of provider audits is expected
• Providers need 1.) a way to estimate their E/M risk, 2.) a consistent way to audit
their charts, and 3.) a consistent record of reports that can be produced to show
good-faith compliance efforts and due diligence when the inevitable audit hits

6. 2013: Audits are a massive federal money-maker

7. 2013 numbers:
You can’t make
this stuff up
• More successful audits
in one quarter of 2013
than nearly all of 2011
• Audits have become far
more focused on
overpayments
• RACs are just one of a
half-dozen government
auditing programs
• These numbers don’t
reflect audits and
monies recovered by
OIG, CERT, MACs,
MICs, ZPICs, HEAT,
PSC, DoJ, or private
payer audits

8. 2012: OIG declares war on E/Ms

9. 2012: OIG declares war on E/Ms

10. 2012: OIG declares war on E/Ms

11. 2012: OIG declares war on E/Ms

12. 2012: OIG declares war on E/Ms

13. 2012: OIG declares war on E/Ms

14. Why use an auditing tool?
• Productivity analysis tells you which providers are at risk of being
audited
• Shows you what types of E/M codes to audit, so your chart audits
are not random but targeted
• Saves you money by identifying undercoding as well as
overcoding
• Saves you time by focusing your audits
• Cut audit risk by finding and correcting issues before carriers send
overpayment demands

15. E/M ProCheck Benefits
• You don’t have to memorize guidelines
• There are built-in tips and guidelines making the audit more
authoritative
• The ability to calculate counseling and coordination of care
is built in
• The impact on revenue is immediately recognized
• A professional report is generated at the conclusion of each
patient audit
• It is a useful, easy-to-read training tool for your providers

16. www.decisionhealth.com
What you can expect next
 A brief survey will pop up immediately after presentation –
MUST TAKE TO GET CEUs!
 Please provide your feedback and indicate your level of
interest in the survey
 CEU certificates to be sent via email post-conference
 You will receive a follow-up call from our product
consultants, Erica and Gary
 Custom demos available for your organization before
purchase; training is available for all subscribers after
purchase

17. www.decisionhealth.com
Download the OIG’s hit list of 1,700 NPI numbers
http://decisionhealth.com/pdf/OIG_FOIA_list.pdf

18. www.decisionhealth.com
For questions, price quotes, custom demos, contact:
Erica Evans
Product Consultant
1-301-287-2394
eevans@decisionhealth.com
Gary Belski
Product Consultant
1-301-287-2285
gbelski@decisionhealth.com