You can figure out how much of an outlier he is, by looking at all of the claims billed out over a given time period, and comparing them to CMS's data (http://www.cms.gov/MedicareFeeforSvc...onforPartB.asp)
Here's the 2010 list for E/M: http://www.cms.gov/MedicareFeeforSvc...es&next=Accept
You have to do the math yourself, though - for example's sake, I've figured the percentages for orthopaedic surgeons for you, for established patients:
99211 = 57,398 charges = 1%
99212 = 1,569,779 charges = 19%
99213 = 4,797,461 charges = 59%
99214 = 1,559,479 charges = 19%
99215 = 146,545 charges = 2%
(Math refresher, for those who forgot how to figure percentages: add them all together, and then divide each amount by the total ...the total for these charges is 8,130,662, so to get the percentage of 99213's billed, I divided 4797461/8130662...then move the decimal place two places to the right on the answer, and round it to the nearest whole #)
You'd do the same for your provider's raw data to get their percentages, and compare the 2 - (it's a lot easier if you have Excel - you can make a chart with them side by side, and really see where they differ). If your provider is billing 99215's more than 20% of the time, they are far more likely to be audited than someone who bills mostly 99213's, even if the level of service is warranted every time. But, they still get to decide if it's worth the risk, so to persuade them that it's probably not, you can reference this stuff (although, if Trailblazer's not your MAC, you may want to get similar publications from your MAC's website - otherwise, he might dismiss it as 'irrelevant' to him):
Hope that helps!
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