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The OIG Reviewing Evaluation and Management (E/M) Services

Posted By Administration, Wednesday, January 25, 2012

The Office of Inspector General has released its Work Plan for fiscal year 2011. In it, the OIG indicates that evaluation and management (E&M) claims will be reviewed, to identify trends in coding, including a review to determine whether coding patterns vary by provider characteristics.

Additionally, the OIG will conduct a separate review of potentially inappropriate payments for E&M services and the consistency of E&M medical review determinations. Medicare contractors have indicated an increased frequency of medical records with identical documentation across services.

ISIS members are encouraged to familiarize themselves with the E/M coding guidelines to assure compliance with documentation requirements.

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