 Over Billed Evaluation and Management (E/M) Claims Cost Health Plans Over $20 Billion 1. 
Over Payments of E/M Claims Represent up to 3% of Medical Loss Ratios.
Over 10% of E/M Claims are Over Paid Due to Mistakes in Coding 1.
Almost 95% of the Highest Billing and Reimbursement Levels are Miscoded 2.
1. US Dept. of Health and Human Services 2. DHHS Office of Inspector General
Audit and recovery programs traditionally focus on high-cost services and detection of fraudulent and abusive practices. Yet, Evaluation and
Management (E/M) services billings – the most widely used codes – are seldom audited. The reason: traditional audit methods are labor intensive
and expensive. They require sending professionals on-site to medical facilities to conduct reviews of clinical records. The reviews disrupt the
provider community and are often challenged for inconsistent application of coding standards and bias.
 
Actually, we have written the code and developed CODeXACT®, a cost-effective solution for E/M audits. With CODeXACT, we review large volumes
of E/M claims using automated audit tools, data mining techniques, integrated workflows, Web-based technology, and a virtual team of expert auditors
to deliver accurate, defensible, and educational audits.
We help our clients reduce E/M claim over- payments, recover dollars, build a better educated physician network, and sustain reductions in E/M
claims costs.
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