tci ED Coding & Reimbursement Alert - 2011 Issue 8

Audit Tips: Are Your Frequency Distribution Comparisons "Apples to Apples"? Avoid Outlier Designation With This Crucial Advice

Use these tips to defend your distribution.Payer expectations for a normal ED distribution can target your practice for audits, but applying such tactics as asking auditors to provide comparison details can help promote your cause.Here's the scoop. One way payers routinely identify providers for audits is by comparing the frequency distribution of their E/M codes to a broad standard of other providers. Frequency distribution just means tracking the utilization of each code in question as a percentage of the group of codes. In the ED setting, the ED E/M codes and critical care (99281-85 and 99291) are...

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