• E-mail
• Print
• RSS

Tip: Evaluate physician coding profiles

Compliance Monitor, September 1, 2004

Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!

Evaluating your physician coding profiles often results in improved compliance and increased revenue, so it's well worth your time and effort, according to Sharon McGee, RHIA, MS, compliance officer at Ochsner Clinic Foundation in Louisiana.

McGee discussed four categories to watch when analyzing codes:

1. Codes you would not expect to see. They could include code categories, E/M levels, procedures, or modifiers.

2. Codes not being used that you expect to see. If it's unusual for physicians in a specialty not to bill particular codes, why is it happening? Are there codes you should be seeing that you don't? Are you missing opportunities to bill for services that they're providing? Are you not billing because physicians don't understand the coding system?

3. Patterns that differ from the national norms or from others within the group practice. McGee compared providers to others in the practice, as well as to national Medicare data.

4. Assignment of the same level of E/M service. "In our practice, we call it, 'falling in love with the code,' " McGee said. Look for patterns for physicians who perhaps always use threes or fives and find out why.

Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!

• E-mail to a Colleague
• Print
• RSS
• Archive