E/M Auditing

Your benefits:
PMA provides ongoing compliance, education, confidence in documentation, proper code selection, increased revenues and other important benefits.

PMA’s goal is to keep you in continual compliance with the Centers for Medicare & Medicaid Services’ (CMS) Evaluation and Management Documentation Guidelines.

What we do:
We continually monitor your operative reports to ensure documentation compliance and completeness. We randomly choose patient documentation twice a year, from each physician within your practice, and review them based on either 1995 or 1997 CMS guidelines — depending on your particular documentation style.

If we use the 1997 guidelines, we will grade your documentation on its conformity to the Single Organ System Exam Guidelines that suit your practice’s specialty.

We then send a report to each physician — either commending your compliance or outlining the issues that we encountered. We address each chart individually, with suggestions on how to avoid missed reimbursement opportunities.

Why Medical Auditing Is Important To Your Practice:
PMA understands your practice is more scrutinized by government regulators to keep medical costs down and improve efficiency.  Medical auditing is the key to a compliant and profitable practice or medical facility. PMA focuses on conducting internal or external reviews of coding accuracy, policies, and procedures to assure that you are running an efficient and potentially liability-free operation.

Key Reasons For Conducting Medical Audit:

  • Protect against fraudulent claims and billing activity
  • Take action against discovered coding and billing errors to prevent governmental investigational auditors (RACS)
  • Remedy undercoding
  • Correct inappropriate billing of services appropriately provided and documented
  • Identify reimbursement deficiencies and opportunities for appropriate reimbursement
  • Stop the use of outdated or incorrect codes for procedures
  • Eliminate bad unbundling habits and overuse of codes, which lead to warranted audits