Practice Management Alert

The right information can make for a much more productive internal audit

You can focus your auditing efforts with the help of frequency data for your specialty's top codes - and you can obtain such data from the following resources:

1. The Medical Group Management Association (MGMA) has issued its 2004 Coding Profile Sourcebooks for primary care, medical and surgical specialties, pathology, and radiology.
 
Details: The books include CPT and ICD-9 code information for all patients broken down by gender, age category and diagnosis. The MGMA data covers 74 million procedures during calendar year 2003 and breaks down key CPT codes by diagnosis. The data covers younger patients as well as Medicare beneficiaries, so you can track the reasons for patient visits based on age.

2. The Centers for Medicare & Medicaid Services (CMS) and/or your local Medicare carrier can be a good source for E/M code data.

3. Practice Support Resources Inc. and Ingenix both offer benchmarking data and products to help you effectively put the information to use in your practice. You can visit these companies online at www.practicesupport.com and www.ingenix.com.

4. Most medical specialty societies and associations have collected benchmarking data and formatted it for easy use. If your providers belong to a specialty organization, this should be the first place you look for benchmarking data.

Purpose: You can use benchmarking data to compare your practice's use of certain codes against the national average. This analysis allows you to determine whether you're reporting a particular code more or less often than comparable practices. When you identify codes that stand out from the norm, you know what areas of billing to spotlight in your next internal audit.

Don't worry: There may be a reason for your practice's overuse of certain codes due to your patient population. For example, a nephrologist who deals with complicated dialysis patients may report many more level-four and level-five visits than the national average.

Note: For more on preparing for an internal audit, see last month's article "Chart a Course for Ultimate Audit Success in 4 Easy Steps."