Identify E/M Coding Patterns That Need a Closer Look
eClinicalWorks will tell you how many visits a provider billed at each E/M level. What it won't tell you is how that mix compares to any outside benchmark, or to your own practice's. That's the blind spot where audit risk sits.
This analyzer takes that same E/M data and turns it into a provider-by-provider risk scorecard. Coding, billing, and compliance teams get the full 99211 through 99215 breakdown per provider, how far each one's high-level share strays from benchmark, and a ranked list of who crosses the risk line first.
What's Inside This Analyzer?
An Excel workbook that turns provider E/M data into a benchmark comparison, a deviation score, and a ranked review list.
1. Configurable E/M Benchmark Reference
- Benchmark fields are prebuilt for 99211 through 99215, so you're not starting from a blank sheet
- Swap in CMS, MGMA, AAPC, payer-specific, or your own internal numbers, whatever fits your practice
- A running total flags it if your five percentages don't add up to 100
- Notes are included on adjusting targets upward for higher-complexity specialties
2. Provider E/M Distribution Analysis
- Type in each provider's visit counts for 99211 through 99215
- Total visits and per-level percentages calculate on their own
- 99214 and 99215 combine into one high-level share, the number that actually drives audit risk
- Every provider lines up side by side, so patterns across the practice are easy to spot
3. Deviation Flagging & Audit-Risk Prioritization
- Each provider's high-level share gets checked against whatever benchmark you picked
- The gap shows up as a plain percentage-point number, no guesswork involved
- Set your own risk threshold. There's no fixed cutoff imposed here; it's your compliance guidance that decides
- Providers sort by how far off they are, so the worst outliers surface first, not just the busiest providers
4. Provider Risk Scorecard & Operational Visibility
- A quick summary up top: providers analyzed, the practice average, and how many got flagged
- The single highest-risk provider gets called out by name
- Flags do the pointing, so chart audits start where they're actually needed
- Run it again next quarter and see whether coding education actually moved the needle
Built for Healthcare Leaders Responsible for Coding Accuracy & Compliance
Created for the people who have to do something with E/M data, not just look at it: monitoring utilization, flagging variation, and prioritizing audits.
