decisionhealth Newsletters, Part B News - 2015 Issue 5 (May)
Cardio codes lead the way in facility vs. non-facility reimbursement rates
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Article Overview
This short benchmarking article is aimed at coders, billers, and reimbursement staff who need to understand how Medicare payment can vary by place of service. It focuses on broad facility versus non-facility reimbursement differences, cites comparative claim-setting patterns, and points readers to the procedure categories with the largest dollar differentials. The piece is useful for identifying where setting-related payment variation may affect billing review and revenue analysis.
Why This Topic Matters
It helps readers quickly recognize that the same procedure can be paid very differently depending on where it is reported, which is important for coding review, charge capture, and reimbursement monitoring.
What You Will Learn
- How Medicare payment can vary between office and facility settings
- Why practice expense RVUs can affect reimbursement differences
- Which broad procedure categories are highlighted as having large setting-based payment gaps
- How place of service is discussed in relation to claims patterns and denials
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Practice managers
- Reimbursement analysts
Codes Discussed
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