The Importance of Accurate E/M Claims

Medical billing largely depends on the accuracy of the physician’s records. Many times physicians have nothing to do with the medical billing aspect of their practice or facility. This can cause them to be haphazard with their documentation for their patients. It is important to educate physicians about the importance of accurate records to the medical billing department.

With rising healthcare costs, carriers are becoming much less lenient on treatments and procedures being covered. They also have become sticklers for accurate medical billing documentation submissions. If there is anything incorrect on a claim, it gets sent back to the provider without payment.

There are many evaluation and management claims that get sent in that are denied for a lack of documentation. Not only can your medical billing claims get denied, but also Medicare now audits many of the submissions they receive. The word “Audit” could send a chill down any practice’s core.

In order to protect your medical billing department from picky denial reasons, or from Medicare audits, it is absolutely important to have complete and accurate medical records. If records are requested with your medical billing for an evaluation and management visit, check them over before they are submitted. Some physicians can be very vague when it comes to medical billing records. For example, instead of documenting an exam of the gastrointestinal tract, some physicians may document an abdominal examination. This type of medical billing documentation would be at severe risk for down coding since the abdomen is not an organ system and the gastrointestinal tract is.

Sometimes physicians don’t realize how important their documentation is to medical billing. They may think the medical records are solely for their knowledge. Make sure the physicians in your practice are fully aware of the amount of weight their documentation has on medical billing.

View all Articles by: Melissa Clark, CCS-P