decisionhealth Newsletters, Part B News - 2008 Issue 12 (December)
Benchmark of the Week: Ten codes with increasing denial rates
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Article Overview
This benchmark article examines trends in denial rates for selected medical billing codes using 2006 and 2007 CMS claims data. It is aimed at coding and reimbursement professionals who want to understand which code categories saw notable increases, the kinds of services represented, and the role of CMS coding policy changes in those trends. The article provides a high-level comparison of denial-rate movement across several commonly billed services and notes the data source and selection criteria used for the analysis.
Why This Topic Matters
Denial-rate trends can signal changes in payer behavior, claim-edit enforcement, and coding policy impact. Reviewing this type of benchmark helps coding and reimbursement teams spot areas where claims risk may be shifting across service categories.
What You Will Learn
- Which service categories were included in the denial-rate benchmark
- How denial-rate changes were assessed across CMS claims data
- What broad policy and claims-edit factors were associated with changes in denials
- How the article frames the significance of rising denial rates for selected codes
Who Should Read This
- Medical coders
- Coding auditors
- Revenue cycle professionals
- Billing managers
- Healthcare reimbursement analysts
Codes Discussed
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