E/M Coding: Use CBR Insight to Back Up Your Claims

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers how to use Medicare Comparative Billing Report data, carrier benchmarking, and practice-level review tools to evaluate evaluation and management billing patterns. It is written for physician practices, coders, compliance staff, and managers who want to understand how comparative data can help identify outlier patterns, support self-audits, and guide education efforts. The discussion stays at a high level and focuses on the role of benchmarking, chart review, peer comparison, and EHR-generated reporting in coding oversight.

Why This Topic Matters

Benchmarking can help practices spot unusual billing patterns before they become compliance problems or audit issues. Understanding the kinds of comparative reports available and how they fit into routine oversight can improve internal review processes.

Article Sections

  1. See Where Your Practice Falls

    This section discusses comparing a practice’s billing patterns with specialty and geographic peers using Medicare comparative data. It focuses on using the information as a broad benchmark for internal review.

  2. Pull Charts at Random for Best Audit Results

    This section covers the use of random chart review as part of a self-audit process. It also addresses how documentation review and claim review fit into broader compliance monitoring.

  3. Measure Your Stats Against Local Peers

    This section describes comparing coding patterns among clinicians within the same practice. It emphasizes using internal variation to identify areas for review and education.

  4. Don’t Forget to Mobilize Your EHR for Benchmarking, Too

    This section explains that practice systems and EHR reporting can support auditing and benchmarking efforts. It focuses on using system-generated utilization data for practice-wide review.

What You Will Learn

  • How Medicare comparative billing data is used in coding oversight
  • How practices can compare their billing patterns with peer groups
  • How random chart review fits into a self-audit workflow
  • How internal peer comparison can reveal variation in coding habits
  • How EHR and practice management reports can support benchmarking efforts

Who Should Read This

  • Physician practices
  • Medical coders
  • Compliance staff
  • Practice managers
  • Billing supervisors

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