decisionhealth Newsletters, Part B News - 2010 Issue 4 (April)
Benchmark of the Week: Top 10 GPCIs with highest E/M denials, 2007-2008
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Article Overview
This article reviews CMS claims-data benchmarks for evaluation and management denial rates across geographic practice cost indices in 2007 and 2008. It is aimed at coders, billing professionals, compliance staff, and analysts who monitor denial patterns, utilization trends, and regional variation in Medicare claims data. The discussion focuses on broad geographic and service-utilization patterns and on how the benchmark was compiled from outpatient, hospital, and consultation service categories.
Why This Topic Matters
Understanding where denial rates are highest can help coding and revenue cycle teams compare regional performance, monitor trends over time, and recognize unusual patterns in Medicare claims data.
What You Will Learn
- How CMS claims data were used to compare denial rates across geographic practice cost indices
- Which broad geographic areas are highlighted in the benchmark discussion
- How utilization patterns are presented alongside denial-rate trends
- How the article frames year-over-year changes in denial rates and service volume
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle analysts
- Compliance professionals
- Practice managers
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