By Shannon DeConda, CPC, CPC-1, CPMA, CEMC, CMSCS
This auditing and compliance “Tip of the Week” was originally published by the National Alliance for Medical Auditing Specialists (NAMAS), a division of DoctorsManagement.

Living in the “Florida’s Space Coast” we are quite attuned to hearing launch references- and we can certainly relate as we wind down to the 3-2-1 months before the new AMA E&M Guidelines are effective. Kennedy Space Center lists valuable tips for those preparing for a visit for launch, and these tips are well adapted to our upcoming launch.

Step One: Arrive early
Obviously to get the best view of a launch you will want to ensure you have the best spot for parking, tailgating, or the like. Arriving early for the E&M launch includes preparing early and not waiting until the last minute. Do you have a training plan in place? Taking one note per week and breaking it down utilizing 2021 AMA Guidelines is a great way to make the changes relevant through hands-on learning.

Step Two: Save Time
As with most visitor areas in Florida, they do charge admission within certain areas of exploration around the space center- so saving time by advanced ticket purchase is key. A great way to save time with your E&M changes implementation is to start with your EMR. Contact your customer rep, visit their website, and find out what responses they plan to make to best adapt existing formulary templates and internal scoring wizards to the impending changes. While we never condone relying on the use of templates or electronic scoring tools, they are free resources to aid in this transition that saves time for your team as someone else has already created them.

Step Three: Prepare for the Florida Climate
Floridians may laugh at such a prep idea, but it is true… we have sweltering humid heat and rain showers burst that are not normal in many other geographic areas. The new climate and audit culture that will be manifested by the 2021 AMA Guidelines is definitely a concerning area that we should prepare for through creating solid audit and monitoring policies within our organizations. Having your organization implement a 100% pre-bill validation review on January 1, 2021, is a rather extreme measure- although it would provide an excellent adaptation to the new climate of 2021 guidelines.

Rather, consider a less drastic but effective plan of conducting a weekly strategic and random review of 5-10 encounters per provider, per week to ensure coding and documentation accuracy.

Other Items to Bring:
On the website they also suggest bringing things such as sunblock, soft-sided coolers, plastic water bottles, chairs, and of course insect repellent. Other items that can make your launch a success is having tools ready for your providers to know how to appropriately document (NAMAS pocket reference cards now available). Proper training for your coders and auditors as well as an E&M audit tool for the new AMA Guidelines (also just released by NAMAS). Don’t want to pay for these resources- no problem at all- simply Google search AMA MDM chart 2021 and download the PDF chart. This chart does not provide direction for use but does provide a quick reference guide.

The other item you could bring are the articles that have been published regarding each significant change of the new guidelines. Last week, Brenda Edwards did an amazing job breaking down the guidance for the first element of MDM- the number of problems addressed and/or managed. This week’s article will also be a key reference to bring as we turn our focus to the second element of MDM and that is -the Amount and/or Complexity of Data to be Reviewed and Analyzed.

This MDM element took a pretty sweeping overhaul, to include removal of the point scoring criteria created through the Marshfield Scoring Technique and has now been transformed into 3 Category criteria. Within minimal/straightforward scoring of this MDM element, we find that there are no descriptive qualities inferring that these encounters would standardly not include this type of work associated with these patient interactions.
The scoring of Category 1, 2, and 3 then varies based on whether you reviewing the criteria of limited, moderate, or severe.

Limited- this level of data and complexity focuses on the work associated with Category 1 or Category 2. These are the more routine type of services associated with the average patient interaction that could include (Cat 1) ordering test, reviewing test, review of external records, or (Cat 2) obtaining history from someone other than the patient. The requirement within this element would be to find noted 2 of the 3 services in Cat 1, or Cat 2 requirement met.

Moderate– This level of data and complexity takes Cat 2 criteria, obtaining history from someone other than the patient, and moves it up to a Cat 1 criteria element and now requires 3 of the 4 bullets in Cat 1 to be included to meet this level within the MDM. And if that is not confusing enough- Cat 2 for moderate now becomes a different work criterion of independent interpretation of a previously reviewed diagnostic by reviewing the image, tracing, or specimen and providing their own independent interpretation. Moderate level also sees the addition of a Cat 3 level as well which providers credit for the rendering provider discussing the patient with another provider. In order to score Moderate, we must have met the criteria for one of the three categories.

Extensive– This level is, at least, the same as moderate, but we must meet the specifications of 2 categories out of the 3.
Interestingly enough, for the most part, the findings that are scored in this category (orders, review, etc…) are much the same as they were previously, but the scoring mechanics have significantly changed moving from points to a categorization scoring process.

This Week’s Audit Tip Written By:
Shannon DeConda, CPC, CPC-1, CPMA, CEMC, CMSCS

What to do next…

  1. Contact us to discuss your audit needs by calling (800) 635-4040 or email [email protected].
  2. Read more: What can you expect from a coding and compliance review?
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