decisionhealth Newsletters, Part B News - 2012 Issue 5 (May)
NPP Benchmark: NPs, PAs among specialties who bill higher level E/M codes
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Article Overview
This piece reviews a chart derived from an HHS Office of the Inspector General report and focuses on the distribution of specialties among providers who billed higher-level evaluation and management services at consistently high rates. It is intended for coding, compliance, and audit audiences that monitor E/M utilization patterns and external review risk. The article also places the findings in a broader oversight context involving CMS and Medicare claims review, while noting the presence of nurse practitioners, physician assistants, and other nurse practitioner providers in the reported specialty mix.
Why This Topic Matters
The article helps readers understand why high-level E/M billing patterns attract attention from auditors and why specialty mix matters in internal monitoring, education, and compliance programs.
What You Will Learn
- How an OIG report categorized specialties among providers who billed higher-level E/M services at very high rates
- Why E/M billing patterns can be relevant to audit and compliance activities
- Which provider groups were noted as part of the reported specialty distribution
- How external oversight findings may inform internal review and education efforts
Who Should Read This
- Medical coders
- Compliance officers
- Auditors
- Practice managers
- Physician administrators
- Billing staff
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