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Case Study
Revenue Integrity Compass Member since 2010, Terre Haute, IN • 295 Bed Hospital
Revenue Cycle Solutions
Physician Revenue Integrity Compass
Union Hospital Calculates E/M Compliance
Risk Physician Watch List
Action: Identify a single risk metric that can be sorted to prioritize E/M code reviews for
physicians.
• Like many hospitals, Union was being targeted by OIG and Recovery Auditors E/M Code reviews.
These reviews presented compliance risk to every physician at the professional and hospital setting.
• With a growing physician population and limited resources for reviews, the team was eager to develop
a new way to increase efficiency of E/M chart reviews while mitigating more risk. The question quickly
became, how can we identify which physicians present the most risk?
• Diane Hanson and Racheal Peabody, looked to the data in Revenue Integrity Compass to begin
brainstorming a plan.
Challenge: Growing number of physicians and limited resources for conducting chart reviews
Method: Utilize Work Relative Value Units (RVU’s) and Billing data to calculate Provider
Weighted Averages and Distribution Variance.
To get started, Union used Work Relative Value Units (Work RVUs) to reflect the relative
levels of time and intensity required for a service. CMS calculates work RVUs for most
physician billing codes.
Finally, utilizing RVUs and biling data in tandem, Union was able to calculate a
distribution variance on their E/M ranges which they used to build out a risk metric on a
0-100 scale.
Union then pulled the physician billing data in Revenue Integrity Compass to identify
how often each physician bills a targeted E/M code.

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Results: A comprehensive spreadsheet that identified physicians who present the most E/M risk that
allowed Union to increase efficiency and track results.
Meet the Team:
Diane Hanson
Compliance Analyst
Revenue Cycle Solutions
Liam Delap
Dedicated Advisor
For more information, contact
revcycle@advisory.com
Using Physician Revenue IntegrityCompass and the E/M Physician Risk Watchlist Union has
been able to:
• Target:Code sets under scrutiny by reviewers sorted byriskiest physician.
• Focus: resources and education efforts on physicians who will have the highest
volume impact.
• Track: Results after education efforts as evidence of change in physician coding
practices.
= Aa+Bb+Cc+Dd+Ee
= Total RVU/Total
A B C D E
a
b
c
d
e
=((Provider Weighted
Avg. RVU Work/Mean) -
1) * 100
=Distribution
Variance * Total
Racheal Peabody
Compliance