Drug Coding Advisor-HCFA data now available for benchmarking E&M
FOI request no longer needed
Recent policy changes mean the Health Care Financing Administration (HCFA) no longer require you file a Freedom of Information Act request to obtain the raw data files of practice evaluation and management (E&M) coding patterns. And since the information is also free, this makes the data readily accessible to any physician practice.
Because this raw E&M data is grouped by specialty, it's fairly easy to convert to percentages that can be used to compare your billing patterns to national practice patterns, notes Todd Welter of Denver's R.T. Welter & Associates, a consultant for the Medical Group Management Association.
An example
For instance, consider this hypothetical example of the E&M billing patterns of an internal medicine practice which bills 725 out of 924 established patient visits with code 99213. After converting HCFA's data file to a useable benchmark, you find the national average for code 99213 for the same number of patient visits is only 213.
The implication: the practice is probably playing it safe when it comes to its E&M coding — and almost surely underbilling — in an effort to avoid getting caught up in regulatory questions, says Welter.
"You want to use this kind of data to get a doc's attention about the importance of proper coding — and its impact on reimbursement," says Welter.
Converting data files
Here's reimbursement consultant Welter's tips on how to create your own in-house E&M benchmarking database.
1. Access HCFA's main Web site: www.hcfa.gov.
2. Click "Stats & Data."
3. Click "1999 Resource-Based Practice Expense Data Files."
4. Click "1998 Procedure Code Utilization-By-Specialty," then download the data.
5. Find your specialty.
6. Look for the specific series of E&M you want to examine more closely.
7. Convert this national info to a percentage benchmark. For instance, if there were a 1,000 total for the series, and there were 240 "1s," then the percentage of "1s" is 24%. If there were 360 "2s," then the percentage of "2s" is 36%.
8. Create your own in-house base comparison by converting codes used by individual physicians — or the entire practice — to a percentage for each series.
9. Compare the national percentages for each "1" through "5" E&M entry to the numbers your practice actually coded for that series. For example, if the national average for a "2" in the series you are examining was 14%, and you coded 10,000 of those codes, your figure converted to the national average would be 140.
10. Compare your number for that code to the national converted figure.
11. Take your fee schedule and determine how much you billed per code per year.
12. Compare this to the national average.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content