Powerful and Comprehensive
Compare Your Utilization Patterns to That of Your Peers Within Your State and Specialty.
Recently, the OIG made it quite clear that the new health care bill will be funded through the recovery of payments made to providers of health care services. The prime driver for this is the RAC (recovery audit contractor). A RAC is an entity that is contracted by the federal government to identify potential overpayments made to providers, audit their practices and determine just how much is owed back to the government. And RACs are compensated based on a commission of the recovery amount.
RACs, as well as other outside agencies, depend upon profiling to determine which organizations will be audited. In the case of the medical practice, this is done using a number of different metrics, including comparing the practices utilization of procedure codes and modifiers to their peers.
Our procedure code and modifier utilization worksheets are compiled using the most recent P/SPS Master File, which contains data on all claims submitted to CMS during the data period. For this release, our analyses are based upon approximately 2.5 billion claim lines. Each workbook represents one specialty with the data broken down onto five worksheets:
- All procedure codes in rank order by reported frequency. It also shows the rate at which CMS denied payment for those codes.
- All procedure codes in rank order by total submitted charges.
- All procedure codes by total RVU, which is calculated at the RVU for that procedure times the frequency reported.
- The top reported non-E/M modifiers usage on non-E/M codes.
- E/M-only modifiers usage on E/M codes.
The Procedure Code and Modifier Utilization workbook is $99 per specialty. To order, simply select the specialty to benchmark your practice and click the Add to Cart button. Checkout is easy with either a PayPal account or any credit card (a PayPal account is not required).