Detecting physicians that code more than others

New software may assist in taking action over healthcare overcoding and dubious Medicare billing practices in the U.S.

Consulting firm Hayes Management has released new software to help plot the coding behavior of healthcare organisations -- in order to identify which providers are coding higher than others.

The MDaudit software provides an E&M bell curve reporting module as part of the company's MDaudit Professional platform.

In a recent study, a margin of physicians were found to bill higher-level E&M codes consistently more than their peers -- and it is due to this that the new bellcurve software has been developed.

The report, provided by the Office of the Inspector General (OIG), is titled "Coding Trends of Medicare Evaluation and Management Services". The study is part of an ongoing series that focuses on the rising cost of Medicare payments for E&M services, in order to identify coding trends within Medicare, and to monitor physicians who are in the highest coding categories.

It is hoped that this visual software will help auditors detect and become more proactive in controlling billed E&M codes which are higher than 'standard' levels.

The standard process for E&M billing is:

  • Determining the service that is medically necessary.
  • Provide the service required.
  • Documenting the service provided.
  • Selecting the most appropriate code for the patient's procedures.
  • Submitting the service and billing to Medicare.

Overcoding can become a big issue in the realms of healthcare billing. If more tools are developed with the sole purpose of getting to grips with what care providers are offering and whether billing practices accurately reflect this, then it may be possible to target areas of particular concern -- such as high-level E&M billing and consumer protection.

George Andrew, MDaudit Product Manager said:

"The graphs and reports in this module visually illustrate outliers. This allows auditors to be proactive with providers who are overcoding before it becomes a bigger issue."

The reports generated by the bellcurve software typically use CMS data, and can display the frequency of billing separated by provider, campus and specialty. Billing rates can then be analyzed to determine if they are justifiable, or if action needs to be taken.

Image credit: Hayes Management


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