Reimbursement: Think You Should Use a Level 3 E/M Code for Hospital H & P? Think Again

Why This Topic Matters

Understanding comparative billing reports helps practices assess whether their coding patterns are unusual relative to peers and whether documentation supports the services billed. The article is relevant to compliance monitoring, internal benchmarking, and awareness of Medicare review activity.

Article Sections

1. Comparative Billing Report background

   Introduces Medicare benchmarking reports and the role they play in analyzing billing and coding trends across specialties and settings. Describes the organizations involved and the general purpose of the report.

2. Take a Look at the CBR Specifics

   Summarizes the report sample, time frame, specialty focus, and the subset of claims examined. Identifies the E/M service group that was the focus of the analysis.

3. What auditors found

   Reviews the broad categories of claim and documentation issues identified in the audit findings. Addresses the types of problems that contributed to review concerns.

4. What the CBR revealed

   Explains the general findings about billing patterns, documentation emphasis, and review activity tied to the report. Notes the report’s discussion of how visit documentation is evaluated at a high level.

5. Consider These Averages

   Describes the benchmarking averages presented in the report and the broader comparison framework used to interpret practice-level results. Includes discussion of discharge-related utilization patterns and state-level comparisons.

6. Check Your Numbers

   Outlines the article’s advice on using practice management reports and internal calculations to compare billing frequency with peer norms. Mentions the use of system-wide benchmarking for internal medicine practices.