Utilization Benchmarking Audit Tool
Use this MDTool to compare a physician's or an entire practice's evaluation of and management (E & M)
CPT® code utilization to peers in the same specialty and locality. The distribution of utilization by code within each E & M
subcategory is compared to the distribution of paid Medicare claims for physicians in the same specialty nationally and in your Medicare payment locality
Medicare Part B Physician/Supplier Procedure Summary data) .
Utilization benchmarking assists physicians and practice managers and administrators in identifying outlier patterns of E & M coding habits.
These patterns may indicate poor coding practices which could potentially raise significant billing compliance issues in a practice.
Poor coding practices may also produce consistent under coding which would result in lost revenue and also raise a Medicare flag for under serving the population.
Note: If you should find that your data deviates significantly from national and local norms, an appropriate next step may be a focused coding audit.
The E & M CPT Coding Review and Audit MDTool
can be useful in such an audit.
To begin using this tool, we recommend that you generate a procedure productivity report by provider or practice for a specific date range from your practice management system. There are 48 E & M codes that we can evaluate and benchmark for you.
Benchmarking comparisons are with the Medicare Part B Physician Summary Procedure Summary data file released annually, for the prior year's data, by CMS.
MDTools updates this data annually so that benchmark comparisons are with the most recent file available.
Privacy Note: MDTools does not retain any data submitted by users for the purpose of using these tools.