decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Medical_Review_of_Claims / Your_claims_are_reviewed_against_your_specialty
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Article Overview
This article covers how Medicare and carriers group claims information for comparative review and monitoring of billing patterns. It is aimed at physicians, coders, compliance staff, and practice administrators who want to understand the general framework used to compare claims within specialty and practice categories. The article discusses broad Medicare review categories, specialty-based comparisons, and other organizational groupings used in claim oversight.
Why This Topic Matters
Understanding the way claims are grouped for review helps practices anticipate why billing patterns may be scrutinized and what broad categories are used in comparative analysis.
What You Will Learn
- How Medicare organizes claims data for comparison across physicians and specialties
- What broad categories carriers may use when reviewing claims patterns
- How specialty, practice type, and geography can factor into claims analysis
- Why certain service groupings may be relevant to claims oversight
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance professionals
- Practice administrators
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