Medicare Compliance & Reimbursement - 2015 Issue 7
Self Audits: Analyze E/M Trends to See Where Your Practice Fits
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Article Overview
This article reviews how practices can use payer comparative billing reports and random chart audits to understand their Evaluation and Management coding patterns. It is aimed at coding professionals, compliance staff, and physician practices that want a broad view of how their billing compares with peers and where internal review or education may be useful. The discussion covers specialty-based comparisons, pre-bill review concepts, and comparing individual practitioners within the same practice.
Why This Topic Matters
Understanding coding trends can help a practice identify outliers, support compliance efforts, and target provider education before audit issues arise.
Article Sections
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Analyze the Reports
Explains how comparative billing reports are used to review E/M coding patterns across specialties and payer data. The section focuses on broad benchmarking concepts and interpreting practice-level variation.
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Spot Audit Random Charts
Describes a self-audit approach based on random chart sampling and comparing documentation to billed E/M services. The section also addresses internal review, accuracy tracking, and follow-up education.
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Compare Practitioners to Each Other
Covers a second-level internal comparison among practitioners within the same group. The section discusses using peer-to-peer pattern review to identify outliers and support further education.
What You Will Learn
- How comparative billing reports can be used to benchmark E/M coding patterns
- How random chart review can support internal self-audits
- How to compare coding patterns among practitioners in the same practice
- How payer and internal review information can guide provider education
Who Should Read This
- Medical coders
- Compliance staff
- Practice managers
- Physician group administrators
- Billing departments
- Providers
Codes Discussed
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