get_billing_coding_risk
Use when assessing coding compliance risk before an OIG audit, preparing for a RAC review, or building a revenue integrity program. Returns E/M distribution benchmarks, upcoding risk signals, OIG audit priority themes, and RAC watchlist. Example: Cardiology practice E/M mix at 67% level 4/5 visits vs 48% national benchmark — flagged HIGH upcoding risk — OIG cardiology audit focus active in 2024-2025 cycle. Source: CMS and OIG compliance composite.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| specialty | No | ||
| annual_claim_volume | No | ||
| level_4_5_percentage | No | Percentage of E/M claims at level 4 or 5 |