decisionhealth Newsletters, Part B News - 2011 Issue 6 (June)
Benchmark of the Week: High-growth, high-denial drug codes, 2008-2009
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Article Overview
This benchmarking article examines which injectable drug codes showed the strongest utilization growth from 2008 to 2009 and how those drugs performed on denial rates. It is intended for coders, billing staff, and revenue cycle professionals who work with drug claims, payer edits, and contractor-specific coverage policies. The article also discusses why denial patterns can differ by payer and why local coverage policies are relevant when reviewing these claims.
Why This Topic Matters
High-growth drug claims can also be high-denial claims, which affects payment accuracy, claim scrubbing, and payer follow-up. Understanding the general denial and coverage environment helps coding and billing teams identify claims that may need closer review.
What You Will Learn
- How drug claim growth and denial trends were analyzed for 2008 to 2009
- Why denial rates can differ across injectable drug claims
- How payer and contractor coverage policies can affect claim outcomes
- Why local coverage determinations are relevant to drug billing review
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance staff
- Practice managers
Codes Discussed
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