• When was the last time we reviewed our process or improved our technology?
• How accurate is our documentation?
• Can we improve

But it doesn’t have to be this way. Our team at MEREM Healthcare Solutions wants you to know how to be as prepared as possible in case your medical practice finds itself in the middle of a CMS audit this year. One of the best ways to avoid a CMS audit is to be prepared at all times, the best way to do so is by conducting internal audits within your medical practice.

When Was the Last Time You Reviewed Your Process?

Every medical practice has its own unique operations “process.” Is your process working for your medical practice as it should? Internal audits can be helpful in identifying areas of improvement such as your practice management software/technology and can highlight challenges within each step of your revenue cycle from documentation and coding, to billing and collections.

Technology is always changing to provide improved accuracy, especially when it comes to medical billing. If your medical practice is still using technology from years ago, then you may face a higher chance of errors in addition to your team being limited in their ability to work as effectively and efficiently as possible thorough streamlined pms processes.

Conducting an internal audit can allow you to see if the time has come to update your medical practice’s “process,” also known as “technology.”

An internal audit can also prevent revenue loss from occurring, as it can point to where issues are happening so that you can identify areas to focus on improving. For example, if your practice is facing a signifacant amount of claim denials due to coding mistakes, it might be better to consider outsourcing your medical billing and coding to a team of experts that have the experience,and ongoing training for coding within your specialty —like us!

If it has been a while since your last internal audit, you might want to conduct one sooner rather than later.

How Accurate Is Your Documentation?

When it comes to a patient health record, there is absolutely no room for error. Not only can it cause harm to the patient, it can also cause your medical practice harm and possible fines if caught while undergoing a CMS audit.

There should be no discrepancies whatsoever when comparing medical information, such as health records, which should be filled out properly throughout the entire process. Every detail is key.

MEREM Healthcare Solutions Is Here to Help!

A lot of concerns that we’ve discussed with potential clients particularly come from Pain Management physicians because they are a high risk for audits and they want to make sure everything is being coded and billed correctly and ethically to keep them off the grid from auditors.

As we explained earlier, one of the best ways to avoid a CMS audit is to be prepared at all times, which includes conducting your own audits within your medical practice. If you are noticing your medical practice is losing money or you do not have 100-percent faith in your team’s coding accuracy, it may be time for an internal audit! We can help you.

At MEREM Healthcare Solutions, you can feel confident that our knowledgeable and experienced team provides the coding accuracy your medical practice needs in order to keep insurance claims correct and get your medical practice paid for services provided.

Discover how our team at MEREM Healthcare Solutions in Birmingham, AL, can help your medical practice avoid and/or prepare for a CMS audit.

Merem Healthcare Solutions offers services for every step in a practice’s revenue cycle management. We can start from the beginning from credentialing and end with payment posting once an account has been satisfied. We offer a wide range of solutions which include auditing, billing, coding, consulting, credentialing, payment posting, practice management, and pre-collections training. Check us out on our website or feel free to call us to see how. Our customized healthcare solutions can help you run your practice like a well-oiled machine – (205) 329-7519.

The post How Can Your Practice Avoid An Audit? appeared first on MEREM Health.

Heads Up for Healthcare – 

NEW E/M Coding Changes Coming 2019

We all know that change is the only constant in the Medical Coding world. This recent CMS release of coding initiatives in 2019 proposes a pretty significant change for Evaluation and Management (E/M) coding that can impact doctor visits for both the patients and the providers in a good way.

According to CMS Secretary, Verma Seema, “Patients are demanding more accountability from healthcare providers and payers, and they want to see what they’re getting for the high insurance and co-pay amounts paid.”

What patients see, is the attention and time spent with their physician. Physicians complain that the time spent inputting information cuts into face-to-face time with the patient. The pressure to increase patient loads requires providers to keep visits short but effective. Time is the common denominator that will be addressed through these coding changes.

What does that mean for you? Less is more.

The #PatientsOverPaperwork Initiative focuses on value-based healthcare by simplifying the complexity of required documentation during an office visit. This change will enable physicians to return to focusing on attentive, quality care by spending more time with the patient rather than spending their time documenting visit to meet the paperwork requirements involved.

E/M Visit Payment Changes & Reimbursement Rates

• E/M Coding levels 2-5 will be consolidated to a single reimbursement code and must meet the following requirements
  • EPF History (a chief complaint with 1-3 HPI elements)
  • 1 review of symptoms
  • And EPF Exam
  • And a Straightforward MDM

• Add on codes may also be applied for additional reimbursement and payment adjustments.

+     $5 for additional resources in complex E/M visits associated with primary care service

+     $9 for additional resources in complex E/M visits involving non-procedural based care

–      Multiple procedure payment reductions when E/M visit and a procedure are furnished on the same day

+     Add-on for a 30-minute prolonged E/M visit.

• E/M Level 1 rates will be adjusted
  • $24 for established patients
  • $44 for new patients

The proposed changes depicted above are in a 60-day comment period. CMS welcomes and encourages provider feedback as a critical part of the coding change process. This is to ensure that all coding changes benefit not only the patient, but the providers that treat them as well.

“As part of @POTUS‘s Cut the Red Tape Initiative, CMS launched our Patients Over Paperwork Initiative to reduce unnecessary and redundant regulations so that doctors could focus on their primary mission – taking care of their patients.” #PatientsOverPaperwork

— Administrator Seema Verma (@SeemaCMS) July 25, 2018

If you have questions or would like to provide feedback about how these coding changes may effect your E&M visits and reimbursement, you can join the conversation via Twitter using hashtag, #PatientsOverPaperwork and tweet to @SeemaCMS and @MEREMHealth.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008. We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.

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