Session Topic

Making the Case for Moderate to High Risk E/M Services

2020 Evaluation and Management Symposium: Virtual Conference

Presented Thursday, September 24, 2020


Audits began to ramp-up effective August 3, 2020 based on CMS’ notification. This mean Auditors at CMS and other private payors are dusting off their resource manuals. They’ve been a bit vague in the past regarding the highly subjective portions of Evaluation and Management Services, leading to potential denials of services or down-coding of services without proper cause. This session will focus on provider documentation and the “Medical Necessity” of the encounter - ensuring a Moderate or High-level Medical Decision Making is also supported. Get clear on when you can bill legitimately and confidently for higher-level services based on Moderate and High- Medical Decision Making. Don’t miss this opportunity to hear from a regulatory and compliance professional working the front-line of audit appeal defense on a daily basis. Sean will share insights and identify steps and techniques used to successfully defend clients during a payor audit.

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  Sean Weiss, Partner, DoctorsManagement
Sean serves as Chief Compliance Officer for numerous nationally recognized health care organizations; engaged in the development of customized Corporate Compliance Programs including: Standard Operating Procedures (SOPs), Policies, Corrective Action Plans, Investigations and maintaining their Culture of Compliance. Sean has been recognized time and again by clients for successfully protecting their organization from unwarranted penalties and ensuring they receive due process. He has protected thousands of physicians, medical practice groups, and hospitals from undue penalties. In his medical audit appeal defense work Sean and his team of auditing and compliance experts have a proven record of having claims dismissed that had been brought against large and small healthcare organizations targeted by federal (Medicare), state (Medicaid), and commercial insurance payors.