Understanding E/M: 'Fast track' billing lands doctor in the slammer

Why This Topic Matters

It highlights how billing patterns can draw scrutiny even when individual encounters seem routine, and why accurate understanding of E/M time data and utilization patterns matters for compliance and audit preparedness.

Article Sections

1. Federal fraud case and billing pattern scrutiny

   Introduces the enforcement case and the billing pattern that drew government attention. Discusses the broader compliance context for physicians and payers.

2. How auditors assess utilization volume

   Explains the general approach used by government auditors and contractors to compare billed service volume against expected benchmarks. Describes why unusually high annual service counts can increase audit risk.

3. Using physician time data to estimate exposure

   Summarizes the use of CMS-published physician time data and survey-based values for estimating annual billed service time. Presents the general calculation framework without detailing code-selection decisions.

4. Physician time table from the proposed 2012 Physician Fee Schedule

   Provides a reference table of office visit time data from CMS materials tied to the proposed 2012 fee schedule. The table is used as a source of comparative time information for E/M review.