Don has spent over a week developing templates for most specialties, based on the data published by Medicare for services billed to Medicare in 2010 by providers. As a physician, manager or biller, you need to know whether your doctor or physician extender is billing within the parameters of others in their own specialty. This will help you to know if we're flagging an audit, losing money by under-coding or within the utilization average of our colleagues.
As an example, below are the actual percentages of the codes billed to Medicare in 2010 by Addiction Medicine physicians in the country for the different outpatient and inpatient services. The file you will be able to download in Don's Web Store gives you two options. You can download the PDF file for a super low price ($9.50) for any specialty - and show it to your own physician so they can see what the averages are.
You can also download a very easy to use file in Excel and plug in your own physician's numbers so your physician can see a comparison - the way these appears.
The above, looking at the New patient office visits for Addiction Medicine clearly shows the target physician is greatly UNDER-CODING for their level 4 and level 5 visits to the level 2 and 3 code - based on the national average for Addiction Medicine physicians seeing Medicare patients (again - based on actual claims submitted to Medicare in 2010)
The below graph for established patient office visits for this Addiction Medicine physician is very similar in that the target physician is only using the level four code (99214) on 9.5% of their established patients while the national average for Addiction Medicine physicians is that 50% are billed at level 4. This clearly shows the target physician coding far below the national average for their specialty as well, in this area of E&M visits.
In this sample above, you can see that the target physician is coding the highest level of E&M care about 45% more often than the average of all Addiction Medicine physicians in the country that submitted claims to Medicare in 2010. This would be a very good indicator that this practice WILL be audited by Medicare. Keep in mind that if Medicare has this data, so does the other carriers and they too will use Utilization data that they keep on file to determine who to audit as well. Once you insert the physician's data, it will automatically computer the graph and you can add multiple physicians so that each physician in your practice can be compared to each other, as well.
The files (pdf or Excel) will give you the data on each of the folowing (mainly) E&M Coding groups:
99406 - 99407 Behavorial Smoking Cessation visit (we included these so your doctor can see what percentage of the visits are 3-10 minutes and what percentage is over 10 minutes)
We now have these available for the following specialties:
Addiction Medicine
Allergy/Immunology
Cardiology
Endocrinology
Family Practice
General Practice
General Surgery
Geriatrics
Internal Medicine
Interventional Pain Management
Nephrology
Neurology
Neurological Surgery
Ob/Gyn
Ophthalmology
Orthodedic Surgery
Osteopathic Manipulation
Otolaryngology
Pain Management
Pediatric Medicine
PM&R
Podiatry
Psychiatry
Pulmonary Disease
Rheumatology
Thoracic Surgery
Urology
Vascular Surgery
In the near future, we should have it added to the Store for all of the other specialties as well, but I am working on it as quickly as I can.
Keep in mind that the PDF files, which sell for $9.50 are only image files and cannot be changed or modified to calculate your physician's data within the graph the way an Excel file can. This is why the Excel files which CAN and WILL automatically change the graphs sell for $16.25 each.
If you do not know how to calculate percentages (many do not - so don't feel alone), Don created a free Excel file you can download here by clicking EXCEL CALCULATION FILE and you will download an Excel file where you only need to type in the number of times your physician billed for each code during a particular period and it calculates and shows you the percentage.
To access these - please visit Don's Web Store by either clicking HERE or on the link on the left menu.
EMAIL DON 