Evaluation and Management (E/M) Review and Workforce Development

Improving Medical Documentation and Implementing the Use of Data in Medical Decision Making to Increase Compliance and Decrease Risk

Purpose

Psychiatric professionals commonly report Evaluation and Management (E/M) codes requesting reimbursement from a range of payers, including Medicaid, Medicare, Commercial Health Plans, and other state funding processes. E/M service codes are copyrighted in CPT ® by the American Medical Association (AMA). The Centers for Medicare and Medicaid Services (CMS) joined with the AMA to create a major set of revisions to the Office and Outpatient E/M codes (99201-99215) beginning January 1, 2021. The AMA’s and CMS's work to reduce administrative burden has achieved the shared goals of focusing on patient care over paperwork and improving healthcare delivery.

Process

  • Planning meeting with project team to review written plan of roles, responsibilities, and time frames related to the project

  • Audit of sample cases and analysis of E/M forms, documentation, code selection, practice workflow, financial review of cost/revenue and risk assessment.

  • Customized report of findings with recommendations

  • Customized training program for medical providers and leadership

Timeframe: 3 months

Outcomes:

● Improved quality and efficiency of E/M Documentation focused on demonstrating medical necessity, care integration, objective client outcomes, shared medical decision making and diagnostic precision, improved revenue from E/M Services and significant Risk Reduction.

MTM Team

MTM’s Evaluation and Management (E/M) Review Module will provide an objective review of E/M Documentation and Coding Practices, evaluating how well medical necessity, diagnostic precision, care integration, and objective evidence of how medical interventions support client-centered outcomes are established. Organizations receive a customized staff training and report focusing on E/M and documentation compliance, productivity, and financial sustainability. Recommendations regarding practice improvements and process changes are included to support effective, efficient, high-quality E/M service delivery that complies with E/M rules to mitigate risk for the organization and the psychiatric staff.

MD, FASM
Medical Operations, Care Integration & Senior National Council Consultant