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Facility Evaluation and Management (E/M) Audit Risks

About Craneware Insights


Craneware Insights Articles communicate important regulatory changes to Medicare Outpatient billing, Chargemaster (CDM) and coding compliance. Craneware analyzes Transmittals and bulletins from the Centers for Medicare and Medicaid Services (CMS) and other organizations such as Recovery Audit Contractors (RACs) and emails Insights Articles in a focused manner to alert customers to pertinent regulatory changes.

Regulatory News Topic


An article in the August 2005 Medicare Update published by the Arizona Medicare Fiscal Intermediary (Blue Cross Blue Shield of Arizona) has alerted hospitals to an increase in denials and down coding of clinic and emergency room (?ER?) visits as a result of Contractor Error Rate Testing (?CERT?) and medical review. The two (2) main reasons for increased denials and down coded services identified by the Arizona FI were: (1) No documentation of an Evaluation and Management (E/M) service, and (2) No E/M crosswalk on file with the FI.

Date of Insight Article


10-Dec-05

What you need to know and action needed


To view this complete Insights Article including detailed breakdown of Provider Types Affected, Departments Affected, What You Need to Know, Action Needed and Background and Reference links, customers may sign onto Craneware Online Reference Toolkit?.