Specialty Spotlight - Pulmonology: Keep Your E/M Coding Audit Free

Why This Topic Matters

Pulmonology practices are being encouraged to monitor their E/M billing patterns before external reviewers do. Understanding the audit lens used by CMS and contractors can help practices focus internal reviews where utilization differences may raise questions.

Article Sections

1. Know the Approaches CMS Uses

   Overview of CMS audit methods and the broader types of claim issues reviewers may analyze. The section also introduces the role of predictive analytics and pattern-based review.

2. Auditors Seek Patterns

   Discussion of how auditors evaluate claims data, identify trends, and prioritize reviews. This section also covers the use of self-audits and government work plan focus areas.

3. Check These Pulmonology-Specific Examples

   Pulmonology utilization examples based on Medicare data and comparison concepts for practice-level review. The section presents how service frequency can be contrasted with national patterns.