BC Advantage - 2019 Issue 8

Lost in a Pile of Numbers Are Your Doctors Who They Say They Are

As many might know, one of my primary projects is predicting the likelihood that a particular provider may be audited and if so, which procedures codes and/or modifiers are most at risk. To a large degree, the type of target acquisition conducted by government and private payers relies upon a core benchmark of peer-based utilization, and while that may not be the entire story, it is the introduction for sure. This initial benchmark is conducted based on the specialty of the provider being reviewed, so it would stand to reason under the GIGO (garbage in, garbage out) assumption that...

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