Validating CPT typical times for medicare office evaluation and management (E/M) services

Medical Care Research and Review

Volumn 63, Issue 2, 2006, Pages 236-255

  Cromwell, Jerry ^a   Hoover, Sonja ^a   McCall, Nancy ^a   Braun, Peter ^b  

^a RTI INTERNATIONAL   (United States)

^b NONE

Author keywords

Medicare Fee Schedule; Office visit times; Physician office payment; Physician upcoding; RBRVS

Indexed keywords

ARTICLE; CONTROLLED STUDY; CORRELATION ANALYSIS; DERMATOLOGY; GOVERNMENT; HEALTH CARE MANAGEMENT; HUMAN; MEDICAL FEE; MEDICAL INFORMATION SYSTEM; MEDICARE; PHYSICIAN; PRACTICE GUIDELINE; PROSPECTIVE PAYMENT; PUBLIC HEALTH SERVICE; SURGEON; TIME; VALIDATION STUDY; WORK;

CURRENT PROCEDURAL TERMINOLOGY; HUMANS; MEDICARE; OFFICE VISITS; TIME FACTORS; UNITED STATES;

EID: 33644747440     PISSN: 10775587     EISSN: 15526801     Source Type: Journal    
DOI: 10.1177/1077558705285301     Document Type: Article

References (38)

1. American Medical Association. 1992. CPT 1992: Physicians' current procedural methodology. Chicago: American Medical Association.
2. _. 1997. Socioeconomic characteristics of medical practice. AMA/CHPR SES Survey, Tables 1 and 5. Chicago: American Medical Association.
3. _. 2002. E&M documentation guidelines update, 4/24/2002. http://www.ama.assn.org/emupdate.
4. Andrich, D. 1988. Rasch model for measurement. Newbury Park, CA: Sage.
5. Balkrishnan, R., M. A. Hall, D. Mehrabi, G. J. Chen, S. R. Feldman, and A. B. Fleischer. 2002. Capitation payment, length of visit, and preventive services: Evidence from a national sample of outpatient physicians. American Journal of Management Care 8 (4): 332-40.
6. Blumenthal, D., N. Causino, Y. C. Chang, L. Culpepper, W. Marder, D. Saglam, R. Stafford, and B. Starfield. 1999. The duration of ambulatory visits to physicians. Journal of family Practice 48 (4): 264-71.
7. Braun, P., J. Dernburg, D. L. Dunn, and W. Cohen. 1992. Predicting the work of evaluation and management services. Medical Care 30 (Suppl.): NS13-NS27.
8. Braun, P., and D. L. Dunn. 1999. To the editor. New England Journal of Medicine 341:1619-20.
9. Brett, A. S. 1998. New guidelines for coding physicians' services - A step backward. New England Journal of Medicine 339:1705-8.
10. Burt, C. W. 2002. National trends in use of medications in office-based practice, 1985-1999. Health Affairs 21 (4): 206-14.
11. Burt, C. W., and S. M. Schappert. 2004. Ambulatory care visits to physicians offices, hospital outpatient departments, and emergency departments: United States, 1999-2000. Vital Health Statistics, September (157): 1-70.
12. Bystryn, J. C. 1999. Reimbursement for evaluation and management services. New England Journal of Medicine 341:1619.
13. Chao, J., W. G. Gillanders, S. A. Flocke, M. A. Goodwin, G. E. Kikano, and K. C. Strange. 1998. Billing for physician services: A comparison of actual billing with CPT codes assigned by direct observation. Journal of Family Practice 47 (1): 28-32.
14. Connolly, C. 2005. Medicare monthly premium rising to $89.20 in 2006. Washington Post, April 1.
15. Cromwell, J., J. B. Mitchell, and W. B. Stason. 1990. Learning by doing in CABG surgery. Medical Care 28 (1): 6-18.
16. Florin, R. 1998. A study of RVUs for a series of laminectomy codes using a technique called paired comparisons. Unpublished manuscript.
17. Health Care Financing Administration. 1997. Documentation guidelines for evaluation and management services. Baltimore, MD: Health Care Financing Administration.
18. Iezzoni, L. I. 1999. The demand for documentation for Medicare payment. New England Journal of Medicine 341:365-67.
19. Kassirer, J. P., and M. Angell. 1998. Evaluation and management guidelines - Fatally flawed. New England Journal of Medicine 339:1697-98.
20. Kelwala, S. 1999. To the editor. New England Journal of Medicine 341:1620-21.
21. Kikano, G. E., M. A. Goodwin, and K. C. Strange. 2001. Evaluation and management services: A comparison of medical record documentation with actual billing in a community practice. Archives of Family Medicine 9:68-71.
22. King, M. S., L. Sharp, and M. S. Lipsky. 2001. Accuracy of CPT evaluation and management coding by family physicians. Journal of the American Board of family Practice 14 (3): 184-92.
23. Lasker, R. D., and M. S. Marquis. 1999. The intensity of physicians' work in patient visits. New England Journal of Medicine 341:337-41.
24. Marciniak, T. A., and C. H. Om. 2001. Medicare physician payment for practice expense: Is it refined? Part I office visit reevaluations. Medical General Medicine 3 (1): E10.
25. McCall, N. T., J. Cromwell, E. Drozd, S. Hoover, and P. Braun. 2001. Validation of physician time data: Final report. HCFA Contract no. 500-95-0058, T.O.7, DHHS/HCFA, December 12.
26. Mechanic, D., D. McAlpine, and M. Rosenthal. 2001. Are patients' office visits with physicians getting shorter? New England Journal of Medicine 344 (3): 198-204.
27. Mitchell, J. B., R. Schurman, and J. Cromwell. 1988. The changing nature of physicians' office visits. Health Services Research 23 (4): 575-91.
28. National Center for Health Statistics Public-Use Data Files and Documentation. 1998. National Ambulatory Medical Care Survey (NAMCS). Hyattsville, MD: National Center for Health Statistics. http://www.cdc.gov/nchs/ datawh/ftpsexv/ftpdata/ftpdata.htm.
29. O'Neill, L., and J. Kuder. 2005. Explaining variation in physician practice patterns and their propensities to recommend services. Medical Care Research and Review 62 (3): 339-57.
30. Pothoff, R. F., M. A. Woodbury, and K. G. Manton. 1992. Equivalent sample size and equivalent degrees of freedom refinement for inference using survey weights under superpopulation models. Journal of the American Statistical Association 87:388-96.
31. Proudfoot, M. L. 1993. A critique of the practice-expense values of the Resource-Based Relative Value Scale. Journal of family Practice 37 (1): 57-67.
32. Roethlisberger, F. J., and W. J. Dickson. 1939. Management and the worker. Cambridge, MA: Harvard University Press.
33. Types of payment errors in FY98 found by OIG audit of Medicare claims. 2000. Part B News 14 (March): 7.
34. U.S. Department of Health and Human Services/Centers for Medicare & Medicaid Services. 2001. Medicare program. Revisions to payment policies and five year review of and adjustment to the relative value units under the Physician Fee Schedule for calendar year 2002; final rule. Federal Register 66 (212): 555246-503.
35. _. 2005. Notice of Medicare program: 2005. Five-year review of work relative value units under the Medicare Fee Schedule. Federal Register 61 (87): 19992-20048.
36. U.S. Department of Health and Human Services/Health Care Financing Administration. 1998. Proposed rules. Federal Register 63 (108): 30888-90.
37. Woodwell, D. A. 1999. National Ambulatory Medical Care Survey: 1997 summary. Advance Data No. 305. Atlanta, GA: Centers for Disease Control and Prevention.
38. Woodwell, D., and D. K. Cherry. 2004. National Ambulatory Medical Care Survey: 2002 summary. Advance data from Vital and Health Statistics. Atlanta, GA: Centers for Disease Control and Prevention.