Help is available for benchmarking practices
Help is available for benchmarking practices
A step-by-step guide to pulling down the data
Want to benchmark your evaluation and management patterns to similar practices, nationwide? If so, the Health Care Financing Administration (HCFA) maintains Medicare Part B billing data for physicians’ services. It also makes 1997 specialty-specific procedure code utilization figures available through its Internet home page — which will do the trick.
Using this information, you will be able to view the number of times your specialty billed each CPT code. These national billing patterns can then be used to evaluate your own billing habits.
"Using this information and a few simple calculations, you can determine the frequency with which your specialty billed Medicare for a particular CPT code within its family of codes," points out Brent Baker, a coding and reimbursement expert with the American College of Physicians-American Society of Internal Medicine (ACP-ASIM).
Warning: If you seem to be billing low compared to the national average, consider your local market conditions carefully before automatically rising your rates. Besides wanting to stay competitive, another reason for prudence is that Medicare carriers use these same physician billing profiles to determine which doctors to pick for post-payment utilization-review audits. The physicians most likely to have their payment patterns examined are those whose claims are out of line with the profiles of other physicians in the same specialty practicing in the same area.
Here’s a step-by-step guide from Baker showing how to use HCFA’s online database to find out the frequency and distribution of your specialty’s billing of specific CPT codes:
1. Create a folder on your C drive and name it "Specialty Utilization."
2. Go to HCFA’s Internet home page at www.hcfa.gov.
3. Click on the "Stats and Data" box listed in the left hand column of the site’s main page, which contains a "Welcome to HCFA" heading.
4. Click on "1999 Resource Based Practice Expense Data Files," the second bullet listed under the "Information Clearinghouse" heading.
5. Click on "Procedure Code Utilization by Specialty," which is the fifth option under the "1999 Interim Resource Based Practice Expense Data Files" heading.
6. When you see the prompt to save the database file to your hard disk, click the "yes" button and save the file in the "Specialty Utilization" folder you created on your C drive.
7. Once the file has been saved, exit your Internet browser.
8. Go to your C drive and open the "Specialty Utilization" folder. You will find a file named Specutil.exe; double click on this folder. A DOS window will appear telling you that three files are being uncompressed and deposited into your "Specialty Utilization" folder. The DOS window will disappear once the files have been decompressed.
9. Go to your "Specialty Utilization" folder. In addition to the Specutil.exe file (which you can discard), there should be four other files. Look for the file named Specutil.mdb and open it in Microsoft Access or another database program.
If you have a recent version of Access software, you will be prompted to convert or open the file; choose to convert the file. You will then be prompted to save the file; save it in your "Specialty Utilization" and assign it a new file name.
10. A box will appear asking you to acknowledge the AMA’s copyright; click on the "OK" button. In Microsoft Access, you will see three tables.
• A note on nonfacility PE-RVU; disregard this information.
• A specialty code description table; this file lists all the specialty designation codes. For example, the specialty designation code for internal medicine is "11" and the code for rheumatology is "66." You will use the two-digit number for your specialty to locate the relevant data in the utilization database.
• A utilization table; this table contains utilization data per code for each specialty. The table, which contains a massive amount of information, has headings of: CPT (HCPCS) code; modifier, HCFA specialty code; facility indicator; and allowed service.
Take the following steps to determine the frequency and distribution of billings for a family of codes:
1. Select a family of codes.
2. Find the appropriate specialty code and total the "allowed service" column for each individual CPT code. Note: A single specialty may have more than one allowed service number for a single CPT code because of modifiers.
3. Add the allowed services for each CPT code to arrive at the total for the specialty for a family of codes.
4. Divide the total allowed services for each individual CPT by the total allowed services for the family of codes to arrive at a percentage for each individual code. The percentage for each code signifies the frequency with which it is billed compared to the other levels of service within its family of codes.
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