Internal Audit Exercise
The practice is a 40-physician emergency medicine group employing all board certified (ACEP)
emergency medicine physicians. The group is contracted to staff the hospital's main campus
teaching hospital emergency department and three freestanding remote emergency departments.
There are about 100,000 emergency encounters each year for the group and the four departments.
The 40 physicians work an equal number of shifts during the year. For those 100,000 encounters,
the group as a whole reports 143,787 individual CPT codes on claims in a year. Of those, 103,852
are evaluation and management codes (from 99281-99292); 28,093 are ECG interpretations
(93010); the remaining 11,842 codes represent non-evaluation and management services
distributed throughout CPT and HCPCS. The group employs four certified coders (AAPC CPC) who
abstract the dictated encounter notes and code the encounters for claim submission.
Taking budget constraints into account, you are asked to create an internal presubmission code
audit program for compliance purposes. How would I set this up/start this?