decisionhealth Newsletters, Part B News - 2010 Issue 3 (March)
Benchmark of the Week: Differences in consult and E/M denial rates
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Article Overview
This article examines how the elimination of consultation codes affected specialty billing patterns by comparing average denial rates for consult services and evaluation and management services. It is aimed at coders, billing staff, and practice managers who want to understand broad denial trends by specialty and the operational implications of the consult-to-E/M transition. The piece also discusses the data source, the method used to compare denial rates, and general factors that may influence denial changes.
Why This Topic Matters
It helps readers gauge whether the shift away from consultation codes may increase or decrease denial exposure for different specialties and why those differences may matter for billing performance.
Article Sections
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Summary
A high-level overview of the article’s focus on denial-rate differences between consultation services and evaluation and management services across specialties.
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Breakdown
An explanation of how the comparison was derived from 2008 utilization data and how the chart should be interpreted at a broad level.
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Takeaways
General observations about specialty patterns in the denial-rate comparison and related billing considerations in the post-consult environment.
What You Will Learn
- How the article frames denial-rate differences between consult services and evaluation and management services
- What data source and comparison method were used at a broad level
- Which specialty groups are discussed as having different denial-rate patterns
- What general billing considerations are associated with the transition away from consultation codes
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle professionals
- Physician practice administrators
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