decisionhealth Newsletters, Part B News - 2009 Issue 4 (April)
Benchmark of the Week: Denial rates by specialty, 2005 vs. 2007
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Article Overview
This article reviews changes in denial rates across major medical specialties and places those trends in the context of utilization shifts and broader claims-volume patterns. It is aimed at readers who monitor reimbursement benchmarks, specialty performance, and claims data trends, especially within Medicare Part B reporting. The discussion also notes how external enforcement and billing environment factors may relate to denial-rate changes for certain specialties.
Why This Topic Matters
Understanding denial-rate trends by specialty helps coding, billing, and practice-management professionals gauge whether claim outcomes are improving or worsening in specific areas. The article is useful for identifying broad market changes that may affect denial management and operational planning.
What You Will Learn
- How specialty-level denial rates changed over the 2005 to 2007 period.
- How changes in utilization and claims volume can affect denial-rate benchmarks.
- Which broad specialty groups showed lower or higher denial trends.
- How CMS claims data and Part B News analysis are used to frame benchmark reporting.
Who Should Read This
- Medical coders
- Billing professionals
- Revenue cycle staff
- Practice administrators
- Compliance staff
- Healthcare analysts
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