Evaluation and Management (E/M) services represent millions of claims and billions in Medicare payments annually — making them a top priority for U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) audits. Recent sweeping changes to split/shared and Critical Care services in 2024, combined with the OIG’s newly announced 2025 focus on “incident-to” services, have created complex challenges for providers and advanced practice providers across all care settings. Add in the G2211 add-on code for complex patient care and the conflicting CMS vs. AMA guidance on Critical Care, and staying compliant has never been more complicated.

In this timely webcast, our expert Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill these high-risk E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.

Why This Is Relevant:

With E/M services representing one of the highest-volume, highest-dollar categories of Medicare billing, it’s no surprise they’re under intense federal scrutiny. The OIG’s addition of “incident-to” services to its 2025 audit focus, combined with recent split/shared and Critical Care rule changes and the introduction of G2211, creates a perfect storm of compliance risk. Providers, hospitals, and advanced practice providers must understand these evolving requirements to avoid inappropriate payments, protect revenue, and withstand federal audits.

Learning Objectives:

• Learn where and when E/M services can be performed in a “split/shared” manner and the documentation required
• Understand criteria for accurately reporting “incident-to” E/M services
• Identify common pitfalls that trigger OIG audits for split/shared and incident-to services
• Resolve discrepancies between CMS and AMA guidelines for reporting time-based Critical Care services
• Review OIG’s current focus on E/M services and what auditors are scrutinizing in eMR documentation

Who Should Attend:

C-Suite Executives, Attorneys, Compliance & Auditing teams, Revenue Cycle Services, Patient Financial Services, Patient Billing Managers, HIM Departments, Outpatient Coders & Coding Specialists, CDI Specialists, ASC Directors & Coders, Critical Care Coders & Billing personnel, Facility-based hospitalists & APPs, Private practice physicians, APPs, & coders and billers.