2023 Gastroenterology Reimbursement and Coding Update (On-Demand)

Pdf Summary

This document is a summary of a presentation on auditing best practices in the healthcare industry. The presenter discusses the importance of GI-specific benchmarking and understanding the utilization of Evaluation & Management (E&M) codes prone to audit review. Providers should compare their use of E&M services to benchmarks for their specialty. The presenter provides statistics on E&M office codes for GI specialists.<br /><br />The document also highlights best practices for internal audit processes and compliance tools. These include assigning a staff member to review billing processes, conducting frequent coder training, and performing regular internal coding audits. The presenter emphasizes the importance of communication between coders, billers, and providers to ensure consistency and accuracy.<br /><br />The document then explores different types of payer audits, including those conducted by the Office of Inspector General (OIG), Recovery Audit Contractors (RAC), Zone Program Integrity Contractors (ZPIC), and Certified Error Rate Testing (CERT). The presenter provides information on specific issues pertinent to gastroenterology, such as incident-to and split/shared services, use of modifiers, and the Medicare 60-day rule.<br /><br />Lastly, the document offers guidance on how to respond to a Medicare audit. It advises healthcare providers to take audit requests seriously, provide all requested information, ensure legibility of medical records, and include explanatory notes and supporting documents. The presenter recommends consulting with a health law attorney and being prepared to contest audit findings.<br /><br />Overall, this document provides an overview of best practices for auditing and compliance in the healthcare industry, with a focus on GI-specific benchmarking and responding to payer audits.

Asset Subtitle

Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Keywords

auditing best practices

healthcare industry

GI-specific benchmarking

Evaluation & Management codes

internal audit processes

compliance tools

payer audits

gastroenterology

Medicare audit

health law attorney