Look for outliers when auditing E&M coding

When you know you’ve earned your reimbursement appropriately, don’t surrender to the well-publicized threat of compliance hassles and possible fines that too often nudge physicians toward downcoding services. Stay on the proper “middle path” by occasionally checking your evaluation and management (E&M) coding against national benchmarks.

When it comes to benchmarking E&M codes, “average is good.” If your E&M coding rate resembles national averages, you’re less likely to draw regulatory attention. Significant outliers catch the eye of the Centers for Medicare & Medicaid Services' inspectors and commercial auditors, and that can be troublesome unless you really handle many more complex cases than most physicians in your specialty.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.