KarenZupko & Associates Offers Physician Practices Powerful Anti-Audit Tool

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KarenZupko & Associates’ powerful new E&M Profile Analyzer tool can help a physician detect and solve these issues before they become serious problems for the practice.

Physicians may risk being audited or losing revenue, according to a leading national physician practice consulting firm, unless they pay attention to how their close their coding patterns match their peers’. KarenZupko & Associates’ powerful new E&M Profile Analyzer tool can help a physician detect and solve these issues before they become serious problems for the practice.

The E&M Profile Analyzer allows a physician to compare his/her practice's E&M coding patterns to the state and national averages for his/her specialty, using the most recently published data from the CMS claims database. A Microsoft Excel spreadsheet format was added this year, automating calculations and saving valuable time.

The E&M Profile Analyzer is available for 12 specialties in 50 states, including orthopaedics, otolaryngology, hand surgery, physical medicine/rehabilitation, pain management, neurology, and plastic surgery. Comparing internal coding patterns to this benchmark data is the easiest and fastest way for a practice to spot unusual over-or-under code utilization. It is, in fact, a method used by Medicare carriers when selecting practices to audit. By reviewing data quarterly, a physician can predict future audit risks or spot potentially lost revenue and take action! The E&M Profile Analyzer covers codes 99201-99313.

How It Works

KZA's E&M Profile Analyzer is e-mailed automatically after purchase (see http://www.karenzupko.com/products/em_profileanalyzer/emprofile_main.htm).

The Profile Analyzer comes with instructions for multiple usage, allowing a user to generate both individual and group profiles. It is easy to obtain maximum results with the tool - it comes with a training video accessible right on a desktop! After running a CPT frequency report from any billing system, the physician simply enters the frequency for each E&M code in the designated column on the spreadsheet. The Profile Analyzer is already set to calculate the percentage of use for each level of code in each category.

KZA's E&M Profile Analyzer also provides a graphical comparison of a practice’s frequency to the state and national averages, so that busy physicians can review results quickly.

What It Tells A Physician Practice

A graph that is in line with state and national graphs shows a practice that does not profile too differently than others around it for established patient codes.

Graphs skewed to the left signal a higher utilization of low-level codes, which may result in potentially lost revenue. The graph attached at right shows the example of an orthopaedist in New York (Empire) whose overuse of 99213 may be costing him valuable reimbursement. (Auditing actual chart notes for under-or-overused codes will tell him for sure.)

Graphs skewed to the right show a more frequent use of higher-level codes. Physicians with a subspecialty may profile this way when compared to their generalist peers. Practices displaying an unusual number of higher-level codes may be at risk for an audit - verifying the documentation and medical necessity supporting the codes billed is a must. The second graph at right shows the example of a Neurosurgeon in Alabama whose level 4 established patient code usage may pose an audit risk.

The Next Step: Get an Expert Opinion

Whether the profile signals overutilization or underutilization of these codes, KZA's chart auditing service will provide the assurance every practice needs that its coding is correct. For a flat fee of $875, a KZA consultant will review six E&M notes and provide specific, written feedback. Alternatively, an onsite educational seminar, Documenting and Coding for Evaluation and Management Services, can be scheduled. In this two to three hour program, we cover the ins and outs of selecting a category and level of service code, as well as the requirements for documentation. For additional information on our onsite speaking services, please call our office at (312) 642-5616 and ask for Bridget Kies.

How to Order the E&M Profile Analyzer

The E&M Profile Analyzer can be ordered from our website at:

The Profile Analyzer is $125 for each specialty in a state and may be purchased with a Visa or MasterCard from our online shopping cart. To inquire about custom orders for specialties not listed here, or for orders of multiple states or specialties, please call our office at (312) 642-5616 and ask for Bridget.

About KarenZupko & Associates

KZA is a national practice management consulting and training firm based in Chicago, with associates nationwide. Since 1985 the firm has consulted with thousands of physicians on issues such as operational systems, coding and reimbursement, managed care administration, marketing, and strategic planning.


Bridget Kies


KarenZupko & Associates, Inc.

625 North Michigan Avenue, Suite 702

Chicago, Illinois 60611

Telephone: 312-642-5616 x21

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Bridget Kies
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