Q: How do I know what E/M level I should be applying to my services? A: Using an audit tool that complies with CMS (HCFA) Guidelines prior to billing charges on a regular basis along with formal staff training ensures accurate E/M level coding. Q: How do I know if my practice is being audited? A: Medicare has already begun sample auditing of medical practices. If your practice has already received gold letters requesting medical information for pre-payment review, this is a sample audit. Q: What happens if my practice fails the sample Medicare audit? A: Medicare will request 50-100 post payment medical inquiries. CALL YOUR PRACTICE ATTORNEY. Medicare will audit these notes and if 20% are incorrect they will assume 20% of all claims submitted in the past year are noncompliant and request a refund from your practice. CALL YOUR ATTORNEY BEFORE PAYING THIS REFUND! Q: What are the penalties for non-compliance? A: Civil money penalties of $2,000 per line item, up to $10,000 per claim. (1999 Publication of the OIG Rulemaking) Q: How can I be sure that my notes meet CMS (HCFA) standards? A: Implement a method of documentation that guides the physician through CMS (HCFA) Guidelines. Develop a system that reviews E/M levels chosen on a regular basis. In addition, schedule periodic code reviews, code of the month. Q: How can I make sure that my staff has the knowledge to effectively monitor accuracy? A: Take compliance seriously. Send your staff to conferences and training courses to develop a comprehensive understanding of CMS (HCFA) Guidelines. Periodically have a qualified third party conduct an audit to verify in-house audit results. Q: What areas of my practice are most vulnerable to low productivity and if addressed could increase efficiency? A: Message taking and chart documentation are the areas most vulnerable to low productivity. Train your staff to ask questions that will reduce physician time being spent needlessly. Decrease documentation time and lost transcription tapes. A third party consultation may identify areas within your practice that if perfected would increase productivity and efficiency. Q: How can I hire reliable, qualified staff? A: Train your Practice Manager to hire the right staff the first time. Teach him/her to identify alternative resources for recruitment of qualified candidates. Q. How can I improve patient satisfaction? A. Give the patient your undivided attention and demonstrate to them that you are listening to their problem. Documenting the patient encounter in their presence helps them to realize that they really do have your undivided attention. Q. How can I improve risk management in my office? A: James Otway, attorney specializing in litigation risk issues, states: “The biggest risk area for physicians is failing to document pertinent negatives when dictating. From a legal standpoint the pertinent negatives are as important as the pertinent positives.” Q. How can I spend more quality time with my patients? A. Address issues within your practice that will increase efficiency and allow more effective use of your time. Spending less time returning phone calls and dictating will allow more quality time for your patients. Q. How can I feel confident in the quality of care that patients are receiving from my physician assistants and nurse practitioners? A. Implementing a standard documentation process in which the physician extender is prompted to ask and document important questions during the exam as well as to take vital history information can help ensure that your patients are receiving quality care.