Benchmarking: Why Are Your Hospital H&P Claims Denied? Level 3 E/M Codes Might Be to Blame

Why This Topic Matters

Benchmarking reports can reveal whether a practice’s billing patterns differ from peers and may help identify documentation or coding areas that merit review. For hospital-based E/M services, this can affect claim denial risk, compliance monitoring, and internal audit priorities.

Article Sections

1. Background on Comparative Billing Reports

   Introduces Medicare comparative billing reports as a benchmarking tool and explains the general purpose of the analysis. It also identifies the payer, contractor, and specialty focus of the report.

2. Take a Look at the CBR Specifics

   Summarizes the report’s scope, sample characteristics, review period, and the types of hospital care claims included. It also identifies the E/M services discussed in the analysis.

3. What auditors found

   Lists the broad documentation and claim-completion issues noted by auditors during the review. The section emphasizes the categories of problems associated with the claim errors.

4. What the CBR revealed

   Describes the report’s general findings about billing patterns and the emphasis placed on documentation quality and medical decision-making. It also mentions a separate review activity related to one of the services discussed.

5. Consider These Averages

   Explains the benchmarking comparisons used in the report and presents summary utilization statistics. It also discusses how the report frames results relative to peer groups and national averages.

6. Check Your Numbers

   Discusses how practices can compare their own billing patterns with benchmarking data and generate internal reports. The section focuses on self-monitoring and state-level comparison concepts.