decisionhealth Newsletters, Part B News - 2021 Issue 3 (March)
More Levels 4 and 5 office visits fuel payment gains, despite fewer E/Ms overall
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Article Overview
This piece examines how established office visit evaluation and management claims changed over a five-year period and why overall provider payments still increased even as total claims declined. It is aimed at coding and reimbursement professionals who track Medicare utilization trends, office visit level distribution, and payment patterns within the established patient E/M code set.
Why This Topic Matters
Understanding utilization shifts within established office visit services helps coders, billing teams, and analysts monitor how changing visit-level patterns affect aggregate reimbursement and service mix.
What You Will Learn
- How established office visit claim volume changed over time
- How payment patterns varied across office visit levels
- Why overall reimbursement can rise even when total claims decline
- Which broad claim trends were most notable in the Medicare data review
Who Should Read This
- Medical coders
- Coding auditors
- Reimbursement analysts
- Practice managers
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
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