Challenge

Most healthcare organizations are concerned about Medicare audits. Yet, billing too often under the same code may trigger an audit.


Scenario

A provider was billing DME claims for semi-electric wheelchairs at a DME company. However, they recently learned that billing too often under the same code – in this case, semi-electric wheelchairs – could leave them at risk for a Medicare audit, as most patients only require a standard wheelchair.


Solution

Comparative analytics can help providers determine if they are consistently coding for higher-level reimbursement than their peers, in turn reducing the risk of a Medicare audit.

Within RemitDATA’s solution, the provider can create a version of the Utilization & Analysis report that is filtered to wheelchair procedure codes. The provider can also:

  • Compare the distribution of the codes against each other to see which codes are being utilized most frequently in the company.
  • Compare billing codes to state and national values to see how they compare against peers that are also billing for these procedure codes.
  • Determine whether they are an outlier against the state and national comparisons for the wheelchair codes, which can put them at a higher risk for an audit.

Download the Uncover Medicare Audit Risks by Highest Reimbursed DME Procedure Codes PDF