The Impact of the 2021 Evaluation and Management (E/M) Coding Changes

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How have your providers adjusted to the 2021 coding changes? Have your coders/educators provided routine documentation review and feedback?

In April the Academy of Professional Coders (AAPC) posted some surprising results of a case study regarding the impact of these changes in the latest issue of Healthcare Business Monthly.  Prior to the 2021 coding changes, the national average accuracy of assigning proper E/M levels by providers was 91%, however, with the new guidelines this mastery dropped by 10%.  It may come as a shock to learn that most of the inaccuracies occurred from Undercoding the E/M level. There is widespread hesitation on the part of physicians to “up-code” mainly based on the long-standing documentation and coding habits developed from 27 years of using 1995 and 1997 guidelines.

The question is, “How many of your providers are like the 20-30% of providers in this case study and are Undercoding” and leaving revenue on the table?  How many are in the 5-10% Overcoding?  What could these findings mean to your health system, hospital, or physician’s office?

It is no secret healthcare organizations today are revenue challenged and could use additional revenue, but how do you quickly locate the providers with the most potential opportunities?  And all of us want to mitigate our potential risk of an audit, and need to do it quickly and efficiently, but with staffing shortages at an all-time high how do we accomplish all these tasks, and fast?

Use of Smart Technology

revealMD smart technology quickly identifies/isolates the providers over or under coding E/M levels compared to their peers (both internal and national) and enables you to see the actual risk within minutes!  This enables a health system with limited resources (staff) the ability to quickly focus their audit efforts on the specific subset of providers with revenue opportunities and provide the education to support higher E/M codes.

Conversely, if the documentation does not meet the guideline requirements creating an audit risk, it  provides coders/auditors/educators the opportunity to educate providers on medical necessity requirements and provide instruction on documentation improvement. Additionally, you can track and trend data over time showing plans/efforts/improvements made in education and training processes and documentation.

For more information on Fi-Med Management Services, call us directly at 262.788.9244 or email

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