decisionhealth Newsletters, Part B News - 2010 Issue 11 (November)
CMS data: 99213 dominates utilization, not reimbursement
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Article Overview
This article examines CMS/Part B News data on office and outpatient evaluation and management services and compares utilization patterns with reimbursement patterns across a recent multi-year period. It is aimed at coders, billers, and revenue cycle professionals who monitor E/M coding trends, payer mix, and payment distribution. The piece provides a data-focused overview of how commonly used visit levels have changed in relative frequency and in their share of reimbursement.
Why This Topic Matters
Understanding how utilization and reimbursement diverge for common E/M visit levels helps practices monitor coding mix, revenue trends, and documentation habits without assuming the most frequently used code is also the primary driver of payments.
Article Sections
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Utilization trends for established patient office/outpatient visits
This section discusses relative use of common office and outpatient E/M services and how their share of overall utilization has changed over time.
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Reimbursement trends for established patient office/outpatient visits
This section compares payment distribution for the same set of services and contrasts reimbursement patterns with utilization patterns.
What You Will Learn
- How CMS/Part B News data can be used to compare utilization and reimbursement patterns
- How relative visit-level usage can shift over time in office/outpatient E/M services
- How reimbursement distribution may differ from service frequency in the same E/M category
- What kinds of reporting can inform coding and revenue monitoring
Who Should Read This
- Medical coders
- Professional billers
- Revenue cycle staff
- Practice managers
- Compliance teams
Codes Discussed
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