Question Out of sync with national level average?

wynonna

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If an ENT office is billing more level 4's than the national average, is this concerning? Looks like 99213 comprise 60% of office visit billing for established pt. And 30% for level 4's is national average for established patients.
We seem to bill 99214's at a higher percentage than 30%. Is this a potential problem with interpreting new guidelines?
(I went under Resources, medical coding tools, E/M utilization tools, specialty and calculate.)
 

thomas7331

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If your practice's billing is an outlier compared with other practices of the same specialty, then you are potentially more likely to be audited by a payer. If your documentation supports what you've billed, then all that will usually happen is that they'll sample a few records and then leave you alone. This isn't really a concern unless your documentation does not support the levels billed. But if a payer finds that your levels are consistently not supported by documentation, this can create a lot of trouble and extra work for the practice.

If you've already identified that you are billing more than the average, my recommendation is that your next step should be to conduct an audit of some of your own records (either internally or using an outside consultant) to validate that your coding is accurate so that you can make any necessary corrections and avoid ending up having a problem with a payer in the future.
 

wynonna

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Upon further scrutiny, and looking at several days of office visit billing, we appear to be on par with the national average. So our billing doesn't seem to be an outlier compared with other practices.
thank you
 
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