More often than not, providers under-code their services as a precautionary measure against audit/recoupment. Time spent (including post-visit reviews) and the medical decision-making complexity of the problem addressed are the primary drivers of codes. We see a significant number of physicians avoid/under-code 99214 for the fear of an audit. This can result in significant revenue loss when measured annually.
EMRs provide tools to track these parameters for coding. Time spent can be easily tracked and measured. Complexity is measured with ICDM codes. The expectation by payors is that you provide the most specific and accurate codes that support the level of service.
We see audits, recoupments, and automatic down-coding happen when the charge profile for any provider is an outlier. Even though the underlying reason for being an outlier could be increased productivity, payors tend to audit anyway. Providers must be extra careful with documentation to avoid recoupment, and under coding may not be the right solution.
Beginning in 2021, coding has been greatly simplified with clear time-based or complexity-based guidelines. You can develop simple practice-level cheat sheets that can guide all providers in a practice to code appropriately.
In GlaceEMR, we provide tools to help you code as well as monthly coding pattern graphs to help you manage coding practices that are appropriate and compliant.