decisionhealth Newsletters, Part B News - 2021 Issue 8 (August)
Per-patient E/M payments fluctuate by state; use them for audits
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Article Overview
This article discusses Medicare’s geographic per-patient payment data for evaluation and management services and how the figures can be used as a comparison point in internal audits. It is aimed at practices that want to understand regional payment variation, assess their own E/M claim patterns, and work with CMS data tools to generate state- or county-level comparisons. The article also highlights why local averages may differ from national figures and how reporting fields in the CMS data portal support this kind of review.
Why This Topic Matters
Payment patterns can vary significantly by geography, specialty, and patient mix, so practices need a local benchmark when reviewing E/M claims. Understanding the available Medicare data helps practices assess whether their payments appear unusual and prepares them for payer or auditor scrutiny.
What You Will Learn
- How Medicare geographic payment data can be used as a benchmark for E/M claim review
- Why state-level averages may differ from national averages
- How CMS data portal filters support state and county-level analysis
- How exported payment data can be organized for internal review
Who Should Read This
- Physician practices
- Medical coders
- Billing staff
- Compliance teams
- Practice auditors
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