MGMA offers chart auditing and coding education services
You must ensure you are correctly reimbursed, and your coding practices not only impact your bottom line but are also subject to documentation and compliance guidelines. Enlisting our coding experts to complete periodic chart audits and provide advice is a best practice that will positively benefit every aspect of operations.
Medical Record Compliance Audit/Risk Assessment Checklist
Assess the quality of your practice’s medical records by selecting a small-but-representative sample of records to review using this form. For more details, please download and review this document.
Evaluation and Management Profile Tool
The Evaluation and Management Profile Tool is designed to allow MGMA members the opportunity to create useful reports that compare their providers' and practices' coding experience with claims data found in the most recent Medicare Utilization Dataset.
2021 E/M Coding, Billing and Auditing Toolkit
These member tools provide a comprehensive understanding of the 2021 E/M coding changes, chart audits and elements of medical decision making (MDM), as well as the Medicare 2021 Physician Fee Schedule.
This tool includes:
2021 Medical Decision Making for Outpatient E/M Codes
— This member tool (PDF) explores the elements for leveling outpatient E/M codes Jan. 1, 2021, and thereafter, as well as time elements for each code; details on the number and complexity of problems addressed to establish MDM; the three categories addressing amount and/or complexity of data to review and analyze; and risk levels for complications and/or morbidity or mortality of patient management.
2021 Medicare Physician E/M Fee Schedule Analyzer Tool (Non-facility)
— This spreadsheet tool allows physician practice leaders to analyze E/M reimbursements for 2020 compared to the final 2021 rate for non-facility charges.
2021 Medicare Physician Fee Schedule (PFS) Tool (Non-facility)
— The 2021 Physician Fee Schedule (PFS) tool (non-facility version) is designed to output the Medicare fee schedule based on data from the 2021 final rule.
2021 Medicare Physician Fee Schedule (PFS) Tool (Facility)
— The 2021 Physician Fee Schedule (PFS) tool (facility version) is designed to output the Medicare fee schedule based on data from the 2021 final rule.
2021 E/M Outpatient Office Visit Codes FAQ
— The biggest questions about the 2021 E/M outpatient office visit code changes are answered by MGMA coding experts.
2021 E/M Audit Worksheet
— This PDF resource includes CPT definitions for elements of MDM for outpatient office visits, as well as guidance on number and complexity of problems addressed; amount and/or complexity of data to review and analyze; risk of complications and/or morbidity or mortality of patient management; MDM risk scores for new or established patient E/M levels; time-based coding; and prolonged services for Medicare and commercial payers.
2021 E/M Quick Reference and Crosswalk Guide
— This downloadable PDF offers a quick reference for new rules for outpatient E/M code MDM, prolonged services and time-based coding elements. Plus
: A crosswalk guide PDF to compare previous E/M guidance to 2021.
Modifier Rate Reduction Information Sheet
Modifiers are used in coding and billing to indicate that a procedure or service has been altered but not changed as defined by the code. It is always two characters that help the payer understand the description of the service provided and adds information to expand on specificity. Some modifiers reduce payment due the alteration of procedural circumstances. The coder must appropriately add modifier based on provider documentation as specified on coding guidelines.