Understanding E/M: Keep an eye on the time to prevent improper E/M billing

Why This Topic Matters

Time-based billing patterns can trigger audit attention when utilization appears inconsistent with typical physician workload. Understanding the broader context of E/M time data and related oversight sources helps practices monitor risk and review billing activity more effectively.

Article Sections

1. Warning signs and enforcement context

   Introduces a fraud-related enforcement case and the broader compliance concern surrounding office visit billing patterns. Summarizes why unusually high utilization can attract government review.

2. Level of risk counted in hours/year

   Discusses how annual physician service hours may be compared with benchmark levels by government auditors and contractors. Focuses on utilization patterns as an audit-risk indicator.

3. Use this formula to calculate your level of risk

   Describes the use of time data and frequency of billed services to estimate annual billing exposure. References official physician time resources and a table of office visit time values.

4. Physician time (in minutes)

   Presents a CMS-issued table of office visit time values associated with commonly billed established and new patient office visit services. The table is provided as reference data within the article.