By Karen Basham

Choosing the correct level of service is extremely important for healthcare providers. Providers must be careful not to undervalue or overvalue their services. There are specific guidelines that providers must follow to determine the appropriate E&M code and the medical documentation must support the code that is used for each office visit.

In order to ward off compliance problems or leave reimbursement money on the table, your organization should make sure that the providers get to know their own E&M utilization curve. Comparing each provider’s coding levels, from level one to level five, to a national benchmark (Medicare, AMA, MGMA, etc.) is a good idea. Most coding patterns should create a bell curve — mostly level three's, lots of level two's and four’s, and a few one’s and five’s. If any provider is coding twice as many level four's as anyone else, it might be a signal to review his documentation and coding.

In order to make the creation of this reporting easier, Precision.BI can assist you in automating this process. We have set up processes for existing clients, to bring external benchmark data into their PBI databases. This allows them to quickly generate the data for the coding utilization graphs. These graphs can then be put on Dashboards, set up in PresentationCenters, or included in automated Scheduler reports that can be sent to each provider.

If you would like to discuss how Precision.BI can assist you with setting up this reporting, contact the Karen Basham in the Consulting Department at kbasham@precisionbi.com.