E/M Bell Curve Analysis - Are Your Providers Billing Outside of the Curve?

Event Information
Product Format
Prerecorded Event
60 Minutes
Product Description

Analyze Medicare E/M Utilization Data to Identify Potential Billing Compliance Risks in Your Practice

Federal and State government payers as well as commercial payers are taking a closer look at E/M billing. Even the Office of the Inspector General has identified vulnerabilities in Medicare program payment related to alleged note cloning, and local Medicare contractors have implemented prospective medical review on certain high level E/M visits.

Join Maryann C .Palmeter, CPC, CENTC in this webinar, where she will help you learn how to compare individual provider and practice data against national Medicare data; identify whether or not your practice is billing in line with Medicare data; identify the risky practice of "cluster billing;" determine next steps to take if outliers are identified; and learn why certain variances may be justified. By analyzing data, you will identify potential opportunities to decrease denials, decrease risk associated with external audits, and even boost reimbursement.

Maryann will also show from where you can obtain E/M data, and get a walk through the process of analyzing the data. Plus, you will be provided with a template that you can use to plot data for your own practice, and learn some common mistakes to avoid when interpreting the data.

Topics covered in the session:

  • Analyze Medicare E/M utilization data to identify potential billing compliance risks in your practice
  • Compare your providers' E/M services against national Medicare data for same specialty providers
  • Compare same specialty providers against one another to identify outliers
  • Learn how non physician practitioners can muddy the data
  • Recognize risky billing patterns and review next steps if aberrant billing patterns are detected
  • Understand some common reasons why your practice patterns may differ from national Medicare data

Some of the discussion points:

  • OIG's understanding of E/M services are you meeting the guidelines
  • CMS's viewpoint on billing E/M services
  • Audit sampling being done by certain RACs
  • Service analyses being done by MACs
  • Prepayment reviews
  • How to identify an ABPS (Aberrant Billing Patterns)
  • Overcoding or undercoding, shureshot risks involved
  • Medicare E/M utilization data
  • Provider speciality codes
  • How and what to look for when performing analysis (through references from CMS website)
  • How well do you know your speciality?
  • NPP vs. Physician speciality code
  • Identifying problematic patterns
  • Top heavy E/M patterns
  • What are the various speciality exam guidelines: Know them!
  • Medical Necessity: as per CMS
  • Tools to analyze E/M codes better

Who should attend : Auditors, coders, compliance professionals, nonphysical practitioners, physicians, and reimbursement directors

Order Below or Call 1-866-458-2965 Today

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About Our Speaker

Maryann C. Palmeter - Medical Coding Billing Expert

Maryann C. Palmeter, CPC, CENTC is employed with the University of Florida Jacksonville Healthcare, Inc. as the director of physician billing compliance, and is responsible for providing professional direction and oversight to the billing compliance program of the University of Florida, College of Medicine - Jacksonville. She has over 30 years of extensive health care experience in both government contracting and physician billing and has been involved in...   More Info
More Events By The Speaker

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