tci Medicare Compliance & Reimbursement - 2019 Issue Q3
Benchmarking: Are Your 99285 Claims in the Outlier Zone?
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Article Overview
This article explains a CMS-linked comparative billing report on emergency department evaluation and management billing patterns. It is aimed at coders, compliance staff, and ED practices that want to compare their Medicare claim mix and modifier usage against national averages, understand the scope of the report, and review the general benchmarking areas covered by the analysis.
Why This Topic Matters
High-level ED claim patterns and modifier usage can signal when a practice is far outside national norms and may warrant internal review. The article helps readers understand what kinds of benchmarking data are available and why they are useful for compliance monitoring and coding self-assessment.
Article Sections
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Here’s What the Report Included
Summarizes the scope of the comparative billing report and the general types of utilization data reviewed across emergency department services.
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Check out the Findings
Reviews the report’s benchmarking results at a high level, including variation in coding patterns, modifier use, and allowed charges.
What You Will Learn
- What a comparative billing report is and how it is used in Medicare benchmarking
- Which emergency department billing patterns were reviewed in the report
- Why practices compare their coding and modifier use to national averages
- What types of compliance review may be prompted by unusual utilization patterns
Who Should Read This
- Emergency department coders
- Compliance officers
- Billing managers
- Physician practice administrators
- Revenue cycle staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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