Physician compliance – a first step

Unfortunately, too many physicians are unconcerned about fraud and abuse. Most are confident that their practice operations are compliant with Medicare billing and documentation guidelines, and that they would never intentionally defraud anyone. True or not, this laissez faire attitude and false sense of security has the potential to hurt physicians financially and professionally by not allowing doctors to focus on the life-blood of their practice - documentation, coding and billing.

So as a first step, perform a Practice Analysis to provide ‘baseline’ statistics and develop a “snap-shot” of the practice’s current operations relative to reimbursement, compliance and operations. This involves a detailed review of all CPT/HCPCS codes and productivity reports for coding compatibility, unrepresented services and baseline statistics, and a detailed comparison of each physicians’ E/M service utilization to specialty-specific Medicare E/M data to identify under or over utilization of level of service codes. The initial results of the analysis are then linked to diagnostic coding and documentation compliance to enhance revenues while reducing post-payment demands from Medicare, Medicaid, etc.