tci Medicare Compliance & Reimbursement - 2019 Issue Q3

Benchmarking: Are Your 99285 Claims in the Outlier Zone?

Use the latest benchmarking stats to see where your practice falls. If a majority of your emergency department (ED) claims are reported with 99285, you may want to revisit your coding practices. Some EDs are billing this high-level code on over 80 percent of their claims, far exceeding the average. That’s the word from a new comparative billing report (CBR) compiled by RELI Group Inc., with which the Centers for Medicare and Medicaid Services (CMS) contracts to develop, produce, and distribute CBR reports. The firm found that the average percentage of services billed to Medicare with 99285 (Emergency...

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