E/M Coding Alert - 2016 Issue 22
Part B Coding Coach: Compare Your Eye Care Practice's Billing Trends Against These National Averages
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Article Overview
This article covers a Medicare Part B comparative billing report focused on optometry practices and the broader value of benchmarking billing patterns against national and state averages. It is aimed at eye care providers, coders, compliance staff, and practice managers who want to understand how billing trend reports are used, what categories of services were reviewed, and what kinds of utilization and documentation issues were discussed. The piece also summarizes general findings related to ophthalmic exams, visual field testing, diagnostic imaging, and modifiers in the context of payer review activity.
Why This Topic Matters
Benchmarking can help practices understand whether their billing patterns differ from peers and can flag areas for documentation review or compliance monitoring. The article shows how payer-generated trend reports can inform internal auditing and practice management.
Article Sections
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Background and report purpose
Introduces comparative billing reports and explains their role in summarizing billing and coding trends for optometry practices. It also identifies the organizations and report context involved.
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Here’s What Auditors Reviewed
Summarizes the broad service categories and claims data reviewed in the optometry analysis. It also notes the general types of issues auditors said were most common.
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Here’s What the Report Revealed
Describes the reporting period and the overall billing patterns identified in the review. This section focuses on national utilization trends and related guidance themes.
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Check This SCODI Stat
Covers the discussion of diagnostic imaging and its relationship to other eye testing services in the report. It also addresses how the analysis evaluated combined-service reporting patterns.
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Check Your Numbers
Explains how practices can compare their own billing frequency and average visit metrics with benchmark data. It emphasizes practice-level review and benchmarking preparation.
What You Will Learn
- How comparative billing reports are used in optometry benchmarking
- Which broad service categories were reviewed in the payer analysis
- What kinds of utilization and documentation concerns were highlighted
- How practices can compare their own billing patterns with reported averages
- Why diagnostic testing relationships are reviewed in utilization analysis
Who Should Read This
- Optometrists
- Ophthalmology and eye care practices
- Medical coders
- Compliance staff
- Practice managers
- Billing staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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