Powerful and Comprehensive Compare Your Utilization Patterns to That of Your Peers Within Your State and Specialty.
Compliance risk assessment has moved to the forefront of concerns for practice administrators, managers and coding professionals. The reason is simple: it’s easier to address the risk in advance of an audit than after the audit is engaged. Recently, the OIG made it clear that the new health care act will be funded by audits of health care providers and the recovery of payments made to them.
Most auditing agencies depend upon profiling to determine which organizations will be audited. In the case of the medical practice, this is done using a number of different metrics, including comparing the practices utilization of procedure codes and modifiers to their peers.
Our procedure code and modifier utilization worksheets are compiled using the most recent P/SPS Master File, which contains data on all claims submitted to CMS during the data period. For this release, our analyses are based upon approximately 2.5 billion claim lines. Each workbook represents one specialty with the data broken down onto five worksheets:
- All procedure codes in rank order by reported frequency, including the rate at which CMS denied payment for those codes.
- New: Enter your counts for each procedure code for a relative risk score!
- All procedure codes by total RVU, which is calculated at the RVU for that procedure times the frequency reported.
- The top reported non-E/M modifiers usage on non-E/M codes.
- E/M-only modifiers usage on E/M codes.
NOTE: This workbook is
delivered via email within one business day of your order.
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