| A Florida-based company, Healthcare Comprehensive Solutions, has been retained by Anthem to conduct audits of physician practices in order to monitor and improve the accuracy of payments. The audits, requesting from 5 to 10 patient charts, are targeted on the use of high-level Evaluation & Management Codes. Before submitting charts to Anthem, physicians should review them to determine if the documentation supports the level of history, physical examination, decision making and time requirements necessary for the E&M code submitted. Physicians have a right to amend a chart record as a late entry before submitting to Anthem. Claims should be reviewed based on the AMA's and CMS 1995 or 1997 E&M documentation guidelines, or whichever provides greater benefit. In cases where Anthem is requesting a refund for alleged overpayments, failure to return such to Anthem within 30 days will result in Anthem deducting the overpayment amount from future claim payments. Members are encouraged to contact the AMC/NOMA's Professional Relations Dept. at 216.520.1000 ext. 314 should they need any assistance with audit compliance or any third party payor issue that may arise. Also, look for the next issue of Practice Management Matters to provide more detailed updates, helpful tools and information for the physician in active practice. If you are contacted for such an audit, call your AMC/NOMA as we will be tracking member feedback throughout this process and continue to provide updates as needed.
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