Creation and Implementation of an Effective Emergency Medicine Coding QA Program

This webinar is AAPC-approved for 1.5 CEU and/or CEDC, CPCO, CPMA specialty credits provided you score a 70% or higher on the post test. Test takers should read all test instructions, and complete the Required Information fields at the top of the test. This test consists of 15 questions. Please select one best answer for each test question by clicking on the square next to the answer you have selected. This test is not timed; however, the test must be taken in one sitting. When all 15 questions have been answered, please click on the Submit Test button. Your score, as well as logic-reach reasoning for answers to any test questions that you missed, will be displayed immediately following completion and successful transmission of this test.

For technical support for your Emergency Medicine Coding and Reimbursement Webinar Library subscription please call or email:
Cari Laplace
Webinar Technical Support Administrator
BSA Healthcare
Phone: 1-561-434-4740
Email: claplace@bsanda.com

Name

Company Name

Email

Random internal coding compliance audits enable comparison of:

Volume and percentage of admissions

The emergency medicine group practice as a whole to national E/M distributions

Individual coder variances to an organization’s internal variance threshold

Revenue potential against down coding reports

In order to create a comparative coder distribution report, which of the following should be deleted from the data pool:

All poorly documented charts that needed to be down coded due to insufficient or poor provider documentation.

All assigned codes – E/M and all other procedure codes

Targeted facilities and coders assigned to each

High volume fast track

Urgent Care centers and departments having Fast Track areas that submit claims using emergency department E/M codes may see a higher percentage of Level Two or 99282 cases.

True

False

_______% of revenue and charges for emergency medicine are based on emergency medicine Evaluation and Management codes.

100%

85%

70%

45%

The emergency medicine industry average for E/M Level One or 99281 is:

0.8%

0.3%

Coders averaging higher than ___% E/M Level Ones or 99281 should be investigated:

0.8%

The emergency medicine industry average for E/M Level Two or 99282 is:

Between 3% and 5%

Between 4% and 6%

E/M Level 4 or 99284 is the largest percentage of revenue loss and compliance risk due to high percentage of payer audits.

True

False

Assuming they code for average acuity emergency departments, coders who average _____% of E/M Level Threes or 99283 should be investigated and should potentially receive additional coder education:

10%

23%

38%

30%

Which E/M code represents the largest percentage of revenue loss and compliance risk in the emergency medicine industry?

Level 2 or 99282

Level 3 or 99283

Level 4 or 99284

Level 5 or (99285)

The emergency medicine industry average for E/M Level Four or 99284:

Varies with the acuity ratio of E/M codes along with the percentage of admissions or transfers, particularly the averages for E/M Level Five or 99285 and Critical Care or 99291

Is approximately 23%

Falls between 4% and 6%

Is approximately 15%

The emergency medicine industry average for E/M Level Five or CPT™ 99285:

Usually varies with the acuity ratio of E/M codes, particularly the averages for E/M Level Four or 99284 and Critical Care or 99291

Is approximately 8%

Usually varies between 10% and 15% above the percentage of admissions and transfers

Usually varies between 10% and 15% below the percentage of admissions and transfers

A percentage of E/M Level Fives or 99285s that is 20% or greater above the percentage of admissions and transfers does not ever represent a potential compliance concern.

True

False

Complete the following statement: A Critical Care distribution should:

Be approximately 2.5% given a 25% admission and transfer rate

Generally increase 1% for each 5% increase in an admissions and transfers rate

Vary between 10% and 15% above the percentage of admissions and transfers

Vary between 10% and 15% below the percentage of admissions and transfers

Which of the following represents a “Tier One” quality assurance issue that should be investigated immediately:

Percentage of Level Twos or 99282s that is between 3% and 5%

Percentage of Level Fives or 99285s that is less than or equal to the percentage of admissions and transfers

Percentage of Level Fives or 99285s that is 20% or more than the percentage of admissions and transfers

Percentage of Critical Care or 99291s that is less than 1%