decisionhealth Newsletters, Coder Pink Sheets - 2007 Issue 4 (April)
How to be proactive in your E/M utilization review
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Article Overview
This article explains how to take a proactive approach to E/M utilization review by examining physician-level billing patterns, comparing providers within the same specialty, and using comparative benchmark reports when available. It is aimed at coding, compliance, and practice management professionals who want to understand broad methods for monitoring documentation support and identifying unusual utilization patterns.
Why This Topic Matters
E/M utilization review is a key part of internal compliance and documentation oversight. Understanding how to monitor billing patterns and compare them against peer and benchmark data can help organizations recognize potential documentation concerns and target education efforts.
What You Will Learn
- How to review physician-level E/M utilization patterns over time
- How to compare providers within the same specialty for outliers
- How comparative billing reports can support utilization review
- How documentation review can be used to assess high-level E/M service claims
- How practice staff may focus on selected documentation elements during review
Who Should Read This
- Medical coders
- Coding auditors
- Compliance officers
- Practice managers
- Physician billing staff
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