decisionhealth Newsletters, Part B News - 2012 Issue 10 (October)
Benchmark of the Week: E/M office visit denial rates, 2009-2011
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Article Overview
This article reviews three years of denial-rate trends for E/M office visit codes and compares patterns between initial and established patient office visits. It is aimed at coding and billing professionals who want to understand payer scrutiny trends, national denial benchmarks, and how office-visit claim denials changed over time. The discussion is framed around Medicare claims analysis and broader payer review activity.
Why This Topic Matters
Understanding denial-rate trends helps practices gauge how their E/M office visit claims compare with national patterns and where payer review attention has been increasing. It provides context for auditing, compliance monitoring, and revenue-cycle analysis.
What You Will Learn
- How office visit denial rates are compared across multiple years
- How trends differ between initial and established patient E/M office visit categories
- How Medicare claims analysis can be used to benchmark denial patterns
- Why denial-rate monitoring matters in the context of payer scrutiny
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Revenue cycle managers
- Practice administrators
Codes Discussed
Code Ranges Discussed
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