Compliance Officers' Forum

  • 1.  E/M Routine Provider Compliance Audits

    Posted 10-16-2025 10:21:00 AM

    Hello,

    I am increasing my passing threshold for Provider E/M audits.  I am wondering what the other AMCs are using for a passing rate -- 80%, 85%, 90%, etc.

    Please let me know if you don't mind sharing.

    Thank you,

    Marcia



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    Marcia Widmer
    Chief Compliance Officer
    Harvard Medical Faculty Physicians (HMFP)
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  • 2.  RE: E/M Routine Provider Compliance Audits

    Posted 10-16-2025 10:45:00 AM

     Our target CPT accuracy for Provider E/M audits is 90%.



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    Eliza Bardin
    Associate Director, Healthcare Compliance
    University of Central Florida College of Medicine
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  • 3.  RE: E/M Routine Provider Compliance Audits

    Posted 10-16-2025 10:49:00 AM

    Our target is 90%. We use a weighted line accuracy, so some errors count less than others. 



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    Amy Jones
    Sr Director of Clinical Billing Compliance
    UAMS Medical Center
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  • 4.  RE: E/M Routine Provider Compliance Audits

    Posted 10-16-2025 11:15:00 AM

    University of Colorado Medicine also uses a weighted line accuracy with differing weights by error and a 90% target for passing.



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    Teri R. Smith EJD, CPMA, CEDC, CPC | Associate Director
    University of Colorado Medicine
    Audit, Compliance & Education
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  • 5.  RE: E/M Routine Provider Compliance Audits

    Posted 10-16-2025 03:18:00 PM

    Thank you!



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    Marcia Widmer
    Chief Compliance Officer
    Harvard Medical Faculty Physicians (HMFP)
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  • 6.  RE: E/M Routine Provider Compliance Audits

    Posted 10-16-2025 11:10:00 AM

    Hi Marcia,

    For Johns Hopkins, our passing score with no further action is 90% and above.  A passing score is also an accuracy rate of 80 - 89.9% but requires feedback and possible completion of a refresher module or other corrective action.  

    Thanks,

    Tammy



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    Tammy Morris
    Compliance Director
    Johns Hopkins University School of Medicine
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