decisionhealth Newsletters, Part B News - 2014 Issue 9 (September)
Denials for prolonged services flat or improved – but watch for telehealth bump
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Article Overview
This piece is for coding and compliance professionals who track Medicare denial patterns, physician fee schedule developments, and telehealth policy changes. It summarizes recent denial trend data for prolonged evaluation and management services, notes a proposed CMS change that could affect telehealth eligibility for certain services, and explains why growing utilization may draw more contractor attention.
Why This Topic Matters
It helps readers understand how policy changes and utilization trends can influence denial risk and oversight for prolonged E/M services.
Article Sections
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Benchmark of the week
A brief framing section introducing the topic of denial trends and the potential impact of anticipated utilization changes.
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Telehealth proposal and expected scrutiny
Discussion of a CMS proposal related to telehealth and the possibility of increased review as service use changes. It references Medicare fee schedule context and oversight considerations.
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Denial rate trends for prolonged services
Summary of Medicare denial-rate patterns across recent years for prolonged service categories and the overall direction of those trends.
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Documentation reminder
A closing reminder focused on maintaining complete records to support claims for these services.
What You Will Learn
- How denial patterns for prolonged E/M services changed over the reported period
- Why telehealth-related policy updates may matter for prolonged services
- What broader compliance concerns can follow increased utilization of a service category
- Why documentation quality remains important when reviewing denial risk
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Revenue cycle professionals
- Physician practice administrators
Codes Discussed
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