decisionhealth Newsletters, Part B News - 2004 Issue 10 (October)
E/M audits: See the steps you should take to sidestep trouble when your carrier compares your utilization to that of your peers
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Article Overview
This article explains how Medicare carrier review of evaluation and management (E/M) utilization can affect practices that may stand out from specialty peers. It discusses the broad kinds of internal review, benchmarking, and documentation preparation that help practices understand their billing patterns and be ready for scrutiny. The piece is aimed at physicians, practice managers, and coding or reimbursement staff who need to assess utilization trends and supporting records without overreacting to a carrier comparison.
Why This Topic Matters
Carrier analysis of E/M billing patterns can flag practices whose utilization differs from specialty norms. Understanding the general preparation steps and data sources discussed here can help practices assess whether their documentation and medical necessity support are ready for review.
What You Will Learn
- How Medicare carrier comparison of E/M utilization can affect a practice
- Why internal chart review and documentation readiness matter before an audit
- What types of practice and patient data are useful when examining utilization patterns
- How specialty mix and patient population factors can influence billing comparisons
Who Should Read This
- Physicians
- Practice managers
- Coding staff
- Reimbursement staff
- Medical office administrators
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