E/M Auditing: Use CBR Data Effectively With These 3 Hints

Why This Topic Matters

Understanding billing pattern data can help practices identify outlier coding behavior, focus audit efforts, and support more consistent internal review processes without waiting for an external Medicare audit.

Article Sections

1. Introduction to Comparative Billing Reports

   Explains the role of Medicare billing comparison reports and how they relate to oversight and practice review. Introduces the general idea of comparing billing patterns with peer groups.

2. Context from Medicare Administrative Contractor Guidance

   Summarizes the contractor perspective on how billing pattern data is compared within jurisdictions and peer groups. Describes the kinds of broad comparisons the reports are intended to support.

3. Use the Reports to Benchmark Your Practice

   Discusses how practices can review their own patterns against state and national averages. Covers the general value of specialty-based comparisons and personalized report requests.

4. 1. See Where Your Practice Falls

   Focuses on using report data to understand where a practice fits among peers. Highlights that comparisons should be interpreted in light of specialty and patient mix.

5. 2. Pull Charts at Random for Best Audit Results

   Describes using report findings as a starting point for chart review and internal audit sampling. Emphasizes the role of documentation review and discrepancy tracking.

6. MAC advice

   Includes contractor guidance on self-auditing and ongoing evaluation processes. Presents the broader reasons practices are encouraged to review claims and documentation regularly.

7. 3. Measure Your Stats Against Local Peers

   Covers comparison of providers within the same practice or local environment. Discusses how internal review can identify variation that may be hidden in average figures.

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

   Describes using electronic health record and practice-management reporting tools for benchmarking and audit support. Notes that these systems can generate usage and productivity data for analysis.