decisionhealth Newsletters, Part B News - 2010 Issue 12 (December)
Benchmark of the Week: New vs. established denial rates by specialty
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Article Overview
This article reviews a chart of denial rates for new and established office visits across specialties using CMS claims data from 2009. It is aimed at coding, compliance, and revenue-cycle readers who want a high-level view of specialty-based denial patterns and the broader context behind utilization and audit focus.
Why This Topic Matters
Understanding denial trends by specialty can help practices compare performance, identify areas for internal review, and place office-visit denial patterns in context without relying on a single specialty’s experience.
Article Sections
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Summary
Introduces a chart comparing denial rates for new and established office visit levels across specialties using CMS claims data. It notes the scope of the specialties included and describes how the chart presents the data.
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Breakdown
Discusses broad denial-rate patterns across specialties for new and established office visits, including relative utilization and overall specialty comparisons. It highlights general differences in denial trends and the context of volume by visit type.
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Takeaways
Summarizes broader trend observations from the chart and notes which visit categories may warrant closer internal review. It also references supplemental access to a larger specialty table.
What You Will Learn
- How denial-rate patterns differ between new and established office visits
- How specialty-level utilization relates to denial trends
- Which broad visit categories are commonly emphasized for internal review
- How CMS claims data can be used to compare specialty performance
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Revenue cycle professionals
- Practice managers
- Physician office staff
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