decisionhealth Newsletters, Part B News - 2014 Issue 10 (October)
2013 data show denials up with lower-level new patient office visit E/M codes
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Article Overview
This article examines 2013 Medicare claims data for office visit evaluation and management (E/M) services, highlighting denial trends over time and how those trends differ by visit level, patient status, and specialty. It also discusses general compliance concerns that can affect claim outcomes, including separately identifiable service billing, global-period issues, and patient status recognition in practice workflows. The piece is relevant to coding professionals, billers, auditors, and practice managers who track E/M denials and reimbursement risk.
Why This Topic Matters
Understanding denial trends and the operational factors behind them can help practices review E/M billing patterns, strengthen documentation and registration workflows, and reduce avoidable claim rejections.
Article Sections
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Benchmark of the week
Introduces the Medicare data trend being discussed and frames the article’s focus on E/M office visit denials.
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Modifier 25 doesn’t help
Discusses general billing and compliance considerations affecting E/M claims when services are reported alongside procedures and other encounters.
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Utilization champ: Internal medicine
Reviews specialty-level denial pattern highlights for commonly billed E/M office visit services.
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How to avoid 99201 denials
Summarizes workflow and record-management considerations intended to support correct patient-status recognition and claim review.
What You Will Learn
- How Medicare denial patterns for office visit E/M services changed over time
- Which broad visit categories showed higher or lower denial activity
- What operational factors may contribute to denials in E/M billing workflows
- Why patient status verification matters for new and established visit reporting
- How specialty utilization patterns can differ within the same code family
Who Should Read This
- Medical coders
- Billing staff
- Compliance auditors
- Practice managers
- Revenue cycle professionals
- Physician office staff
Codes Discussed
Modifiers Discussed
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