decisionhealth Newsletters, Coder Pink Sheets - 2019 Issue 5 (May)
CMS’ billing watchdog sets its sights on E/M encounters in family practice
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Article Overview
This article explains how a CMS-affiliated Comparative Billing Reports assessment examined family practice evaluation and management office visit billing patterns and sent cautionary letters to practices with unusual utilization trends. It is relevant for coders, billing staff, compliance teams, and family practice providers who want to understand the general audit focus, the kinds of utilization measures reviewed, and why office visit billing patterns can draw scrutiny.
Why This Topic Matters
E/M office visit billing is high-volume and often audited, so understanding how peer comparison reports identify outlier patterns can help practices monitor compliance risk and stay alert to potential review activity.
What You Will Learn
- How comparative billing surveillance is used to flag unusual office visit billing patterns
- Why office visit utilization trends can trigger compliance attention
- What broad types of billing metrics may be reviewed in peer comparison reports
- How family practice providers may be affected by audit-related outreach
Who Should Read This
- Medical coders
- Billing specialists
- Compliance officers
- Family practice physicians
- Practice managers
Codes Discussed
Code Ranges Discussed
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