Outpatient Facility Coding Alert - 2019 Issue 9
Audits: Are Your 99285 Claims Above the Average?
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Article Overview
This article examines a CMS-related comparative billing report focused on emergency department billing patterns in Medicare fee-for-service claims. It is aimed at coders, billers, compliance staff, and emergency department practices that want to compare their own utilization patterns with national benchmarks and understand what the report measured at a high level. The discussion covers the report’s scope, the use of emergency department service codes, modifier review, and average allowed charge comparisons without providing full premium details.
Why This Topic Matters
Organizations can use comparative billing reports to gauge whether their billing patterns align with national trends and to identify areas that may warrant internal review. For emergency department practices, the report may help support compliance monitoring and coding audit planning.
Article Sections
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Here’s What the Report Included
Introduces the comparative billing report, the organizations involved, and the broad categories of emergency department billing data it examined.
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Check Out the Findings
Summarizes the report’s overall benchmark findings and discusses how the results vary across providers and settings.
What You Will Learn
- What a comparative billing report is intended to show
- Which emergency department billing patterns were reviewed in the report
- How billing frequencies and modifiers are compared across providers
- Why practices may want to compare their own utilization patterns with national averages
- What types of broad audit questions the report can help inform
Who Should Read This
- Emergency department physicians
- Medical coders
- Medical billers
- Compliance auditors
- Practice managers
- Revenue cycle staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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