Instead, you can blame your selection on Medicare's Focused Medical Review program. Focused medical review involves analysis of Medicare claims data to focus medical review efforts in areas most likely to represent significant overutilization. Instead of blasting away and hoping to hit something with a scatter-shot approach, the carrier focuses its efforts to zero in on its target. HCFA hopes thereby to get the most bang for its medical review buck. Deviations from the norm.
Carriers analyze a variety of information to select aberrant procedure codes.
When a carrier identifies an aberrancy, it analyzes even more data to try to identify the source of the aberrancy and a rationale for it. For example, the carrier analyzes data to determine if the aberrancy is widespread across many providers or the result of one or two providers' billing patterns. Aberrancies can arise from many possible causes, and not all of them are physicians' responsibility. Of course, once the carrier identifies an aberrancy that it can't find an acceptable explanation for, it is bound to correct it. For instance, if the cause is widespread miscoding by physicians, the carrier may provide some education regarding correct coding.