jueves, 10 de octubre de 2013

Practice Benchmarking in the Age of Targeted Auditing: Radiation Oncology

Practice Benchmarking in the Age of Targeted Auditing: Radiation Oncology

Practice Benchmarking in the Age of Targeted Auditing: Radiation Oncology

  1. Ben F. Holland, MBA
+ Author Affiliations
  1. Oncology Solutions, Decatur, GA
  1. Corresponding author: Ben F. Holland, MBA, Kurt Salmon, 1355 Peachtree St, NE, Ste 900, Atlanta, GA 30309; e-mail: ben.holland@kurtsalmon.com.

Abstract

The frequency and sophistication of health care reimbursement auditing have progressed rapidly in recent years, leaving many oncologists wondering whether their private practices would survive a full-scale government investigation. The Medicare Part B claims database provides a complex but rich source of information for physicians seeking to understand how their billing practices measure up to those of their peers, both locally and nationally. This database was dissected by a team of cancer specialists to uncover important benchmarks related to targeted auditing. All critical Medicare charges, payments, denials, and service ratios in this article were derived from the full 2001, 2007, 2008, 2009, 2010, and 2011 Medicare Part B claims databases. Relevant claims were limited using Medicare provider specialty codes 92 (radiation oncology) and 74 (radiation therapy centers), with an emphasis on claims filed from the physician office place of service (11). All charges, denials, and payments were summarized at the Current Procedural Terminology code level to drive practice benchmarking standards. A careful analysis of this data set, combined with the published audit priorities of the Office of the Inspector General, produced germane benchmarks from which radiation oncologists can monitor, measure, and improve on common areas of billing fraud, waste, or abuse in their practices.

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