decisionhealth Newsletters, Part B News - 2010 Issue 10 (October)
Latest CMS data shows growth in E/M utilization for the first time since 2005
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Article Overview
This article reviews CMS Medicare claims data from 2009 and compares it with prior years to show how evaluation and management utilization changed over time. It is aimed at coding and reimbursement professionals who track Medicare volume trends, E/M office visit patterns, and the broader effect of Medicare Advantage enrollment on claims data. The article discusses utilization growth, shifts between lower- and higher-level office visits, and related policy context tied to Medicare changes.
Why This Topic Matters
Understanding broad E/M utilization trends helps coders, auditors, practice managers, and policy analysts interpret Medicare claims patterns and recognize how changes in coverage and beneficiary behavior can affect reported service volume.
Article Sections
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CMS data and Medicare utilization trends
Overview of the reported changes in Medicare E/M service volume and the broader year-over-year utilization pattern. The section places the findings in the context of CMS claims data and Medicare Advantage enrollment shifts.
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E/M codes continue upward shift, but new visits show different pattern
Discussion of office visit utilization patterns across established and new E/M services. The section compares broad level-group movement and changes in relative service volume over time.
What You Will Learn
- How CMS data is used to describe Medicare E/M utilization trends
- What broad shifts were reported between lower- and higher-level office visits
- How Medicare Advantage enrollment can affect the appearance of claims-based utilization trends
- How the article frames differences between new and established visit patterns
Who Should Read This
- Medical coders
- Coding auditors
- Practice managers
- Reimbursement analysts
- Healthcare policy readers
Codes Discussed
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