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.

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