Letting doctors bill E/M services in an audit-free environment is about as risky as playing Russian roulette with a few extra rounds in the chamber, but one Washington practice gave it a shot anyway. It lost $14.5 million in a settlement with the Department of Justice.
Sound Inpatient Physicians Inc. let its 700 providers perform their own coding with “no coding department or trained experts to review coding at all,” according to an article in
The National Law Review. Yes, the term “unsound practices” was in the headline.
While Sound’s practices were finally revealed by a whistleblowing former employee, odds are they would’ve been blown away by an OIG audit any day; the group had been deliberately up-coding E/M services from 2004 to 2012.
“Auditing and training systems were not implemented by Sound Inpatient,” the Review observed. “These programs should be mandatory for all providers and include training, internal audits, and preventive measures against upcoding.”
Sound advice to follow: Use an
E/M auditing tool like E/M ProCheck, which not only identifies providers whose utilization patterns are abnormal compared to their local peers, it’s also a chart auditing program that can perform a chart audit in less than six minutes.
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Evaluation and Management (CEMC™)
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Certified Professional Medical Auditor (CPMA™)
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Physician Practice Manager (CPPM™)