Medicare Compliance & Reimbursement

Plus: E/M services still on TPE checklists.

With Medicare claims reviews coming at you from all sides, you may want to survey your data against those of other providers, both nationally and in your state to gauge where you stats fit in.

A good way to prevent claims calamities is to review federal benchmarking statistics like Comparative Billing Reports (CBRs), generated by CMS and its partners.

CMS’s new partner, RELI Group Inc., published CBR 201902 last month on family practices’ use of CPT^® codes 99201–99205 (Office or other outpatient visit for the evaluation and management of a new patient …) and 99211–99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) and how incorrect coding of these popular E/M visit codes adds substantially to the improper payment rate. Moreover, the CBR studied the propensity some outliers have to upcode to level four or five visits instead of choosing a more appropriate code for the level of care.

Plus: In addition to these CPT^® codes’ prominence on the Comprehensive Error Rate Testing (CERT) report, the Part B MACs currently list E/M office visit codes on their Targeted Probe and Educate active review lists.

Some states’ statistics are far above the national average while others fall far below. Check out three charts that review the top states’ percentages in metrics for the four higher-level E/M office visit codes:

Resource: Find out more about your state’s percentages under the National/State Data link at https://cbr.cbrpepper.org/About-CBR/CBR-201902.