E&M Profile Analyzer
Welcome to the KZA Evaluation and Management (E&M) Profile Analyzer. This powerful tool allows you to compare your specialty and practice's internal E&M coding patterns to national,state and in one comparison, a hypothetical dollar opportunity/risk analysis of your coding patterns. The national and state averages are the most recently published from the CMS claims database. The E&M Analyzer is available for immediate email delivery for 4 specialties; additional specialties are available upon request.
Example of expected utilization:
Legend: Red=Your State, Blue=National Average, Green=Your Practice
Comparing your internal coding patterns to this benchmark data is the easiest and fastest way to spot unusual under or over code utilization. It is, in fact, a method used by your Medicare Carrier when deciding where to audit. Regular review of data generated by the KZA E&M Profile Analyzer allows practices to predict future audit risk and take action, whether that is conducting a chart audit and/or additional coding education.
The KZA E&M Profiler Analyzer's graphical comparison of your data is easy for busy physicians and administrators to quickly review results. In general, the graphical results approximate a bell-shaped curve such as this practice’s data above. If, however, your results are markedly different from the state or national data, a review of documentation is recommended to test completeness and accuracy.
The new Risk/Opportunity Conversion Estimator sheet illustrates a hypothetical dollar analysis using Medicare's reimbursement rates and your locality information to calculate a hypothetical dollar implication of a practice or physicians coding profile.
Another new feature is the Outpatient Consult to New Patient Visit spreadsheet. This sheet snapshots usage patterns for Consults vs. New Patient Visits compared to the national and state data. Overuse of consulatation codes and their dollar premium represent frequent audit targets, underuse can represent dollars left on the table. Again, either the practice or individual physicians can be profiled.
KZA’s E&M Profile Analyzer is available in an easy-to-use Microsoft Excel* format. Don't know Excel, no problem, we've done all the programming. All that's left for you to do is run a CPT Frequency report from your practice’s billing system and enter the frequency for each E&M code in the designated column on the spreadsheet. KZA’s E&M Profile Analyzer instantly calculates the percentages, creates graphs, the hypothetical dollar opportunity/risk and Consult to Visit Ratio reports so your valuable time is spent evaluating your practice and/or physicians’ coding profiles.
Example of potential over-utilization of high level codes:
Legend: Red=Your State, Blue=National Average, Green=Your Practice
Graphs skewed to the right, such as this practice, may signal over-utilization of
high level codes, which often result in audits.
The E&M Profile Analyzer will not address the impact of sub-specialization. When profiled against their generalist peers, physicians with a sub-specialty may display an unusual number of higher-level codes. These may be entirely appropriate if supported by required documentation and medical necessity.
Example of potential under-utilization of low level codes:
Legend: Red=Your State, Blue=National Average, Green=Your Practice
Graphs skewed to the left, such as this, may signal over-utilization of low-level codes,
which results in potentially lost revenue.
The KZA E&M Profile Analyzer, is available by state for $150.00 or two states for $240.00. For orders of more than two states or multi-specialty pricing, email us or call KZA at (312) 642-5616.
*Microsoft Excel version 2000, XP or 2003 or higher or equivalent spreadsheet program must be available on your system to run this product. KZA assumes no responsibility for the accuracy or presentation of outcomes running this program on spreadsheet software other than Microsoft Excel version 2000, XP or 2003.
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