Medical Auditing Practice Exam

What is the first step for an auditor performing a baseline E/M audit?

1. Review all physician charts comprehensively.

2. Run a utilization report of E/M services.

3. Gather all coding manuals for reference.

4. Conduct interviews with the physicians.

The correct answer is: Run a utilization report of E/M services.

The first step for an auditor performing a baseline Evaluation and Management (E/M) audit is to run a utilization report of E/M services. This step is critical as it provides the auditor with a comprehensive overview of the organization's usage of E/M services. Analyzing the utilization report enables the auditor to identify trends, patterns, and anomalies in service delivery, which are essential for determining areas that may require further review. By assessing the utilization report, the auditor can pinpoint specific providers or departments with potentially excessive, insufficient, or inconsistent E/M service delivery. This data-driven approach ensures that the subsequent steps in the auditing process are targeted and effective, allowing for efficient allocation of resources and effort during the auditing process. This foundational understanding sets the stage for a more detailed examination of physician charts or further interviews, focusing on areas that warrant closer scrutiny based on the initial findings from the utilization report.