Medical Auditing Practice Exam

How did the auditor identify that Dr. Jones consistently codes 99212 more often than other providers?

1. By reviewing colleague feedback

2. By examining billing reports

3. By analyzing utilization patterns

4. By conducting peer reviews

The correct answer is: By analyzing utilization patterns

The identification that Dr. Jones consistently codes 99212 more often than other providers is primarily accomplished through the analysis of utilization patterns. This approach involves reviewing the frequency and trends in the codes used for billing services over time, allowing an auditor to spot discrepancies and variations in coding practices among different providers. Utilization patterns reveal not only how often specific codes are employed but also how they compare to the broader standards established within a practice or against benchmarks from similar providers. By focusing on how frequently Dr. Jones uses code 99212 relative to others, the auditor can effectively highlight any inconsistencies that may warrant further investigation. This process is critical in medical auditing, as it provides insight into coding behaviors that may affect billing accuracy and compliance with regulations. By identifying trends through quantitative analysis, the auditor can ensure that coding practices align with medical necessity and proper documentation.