Advanced Search

ED Coding and Reimbursement Alert

Audit Tips:

Are Your Frequency Distribution Comparisons "Apples to Apples"? Avoid Outlier Designation With This Crucial Advice

Published on Wed Jul 20, 2011

Use these tips to defend your distribution.Payer expectations for a normal ED distribution can target your practice for audits, but applying such tactics as asking auditors to provide comparison details can help promote your cause.Here's the scoop. One way payers routinely identify providers for audits is by comparing the frequency distribution of their E/M codes to a broad standard of other providers. Frequency distribution just means tracking the utilization of each code in question as a percentage of the group of codes. In the ED setting, the ED E/M codes and critical care (99281-85 and 99291) are usually considered as a group. Although many payers expect to see a normal "bell curve" distribution, that is not typical in the ED setting. Very few patients come to the ED with low level presentations because of the high copayments and potential long wait times due to triage protocols. Consider the national Medicare [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

ED Coding and Reimbursement Alert

View All