Practice benchmarking in the age of targeted auditing

Area of Science:

• Health Services Research
• Oncology Practice Management
• Healthcare Policy

Background:

• Healthcare reimbursement auditing has increased in frequency and complexity.
• Oncologists face concerns about surviving Office of the Inspector General (OIG) investigations.
• Understanding billing practices relative to peers is crucial for practice viability.

Purpose of the Study:

• To analyze the 2010 Medicare Part B claims database for oncology practices.
• To establish benchmarks for billing, payments, and denials.
• To aid medical oncologists in monitoring and improving billing compliance.

Main Methods:

• Utilized the 2010 Medicare Part B claims database.
• Filtered claims using provider specialty codes for hematology/oncology (83) and medical oncology (90).
• Focused on physician office claims (place of service 11) and analyzed data at the Current Procedural Terminology code level.

Main Results:

• Identified critical Medicare charges, payments, and denial patterns.
• Established practice benchmarking standards based on claims data analysis.
• Correlated data analysis with OIG audit priorities to identify areas of concern.

Conclusions:

• The Medicare Part B claims database provides valuable benchmarks for medical oncologists.
• These benchmarks assist in monitoring and improving common areas of billing fraud, waste, or abuse.
• This analysis supports proactive compliance and risk management in oncology practices.