Medicare Compliance & Reimbursement

Remember: Chart audits are still your most powerful weapon in the war against miscoding allegations.  Medicare's utilization statistics can be an important tool when benchmarking your practice against the general Medicare population as long as you don't rely too heavily on these numbers. In the past, practices were strongly advised to compare their code utilization stats against Medicare's to determine whether auditors considered them to be an "outlier." If, for example, the average practice billed 99215 about 100 times a week but your practice billed the same code 500 times weekly, auditors would probably consider you an outlier and want to audit your records. That can still be the case, in that auditors do look at outliers to determine how a practice looks in reference to others, says Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc. "If a physician's coding statistics are significantly different than others in their [...]