what if you see patients that have more disc injuries? Would you be a higher outlier or a higher provider if you will? Of course. Sam? Sam, I just want to make sure ... I'm not sure if you're advancing your slides or not. We are still seeing the audit prevention and defense. Are you advancing?
Alan Weinstein:
Sam Collins:
Oh, I am advancing the slides, so there is …
Alan Weinstein:
There you go. Now it just changed to the outlier slide, profiling of providers. I'll just leave it at that level. We can just look at it from there though. That will probably be simpler to see.
Sam Collins:
Alan Weinstein:
Now, it's working. Now, it seems to be working.
Sam Collins:
Great. What targets a claim for review? It's really just the profiling and what they're looking at is a comparative billing. Again, if we think of outliers think of someone who is billing a service higher than the average. There is nothing wrong with billing a 99204 or 99205 for that matter. Those codes certainly could be reasonable in a setting but they're not typical. Let's remember that those codes are high risk codes. High risk means that the patients have a high risk of death, high risk of prolonged disability, which is not typical. Therefore, if those are billed very commonly, you've got to make sure that do I have a patient or do I have a diagnosis that really matches it? Again, high level E&M codes will be something that if you use those on a regular basis the tendency is you definitely will get a higher risk of an audit. The next factor is just daily or overly frequent use of evaluation and management services. Doctors do have to be mindful. When you are billing for E&M codes, it is certainly appropriate on a first visit and appropriate about every four weeks to do an exam, however, sometimes sooner depending on the patient's response. Be careful of daily use. Whenever you bill an exam frequently they're going to look to see is there a separately identifiable evaluation and management. Again, not that it's wrong but you have to make sure it is overly frequent. The next factor is just the number of services a provider does. Obviously, it's important to do the services your patients need but you do have to be careful that do you bill many more services than other providers? Typical
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