decisionhealth Newsletters, Part B News - 2010 Issue 2 (February)
NPP Benchmark: NPP vs. physician use of high-level E/Ms, 2006 vs. 2008
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Article Overview
This article reviews a benchmark analysis of CMS claims data comparing non-physician practitioners and physicians in their use of higher-level evaluation and management services across new and established patient visits over a multi-year period. It is intended for coding professionals, auditors, and practice leaders who want a high-level view of utilization trends, denial patterns, and how provider type can affect E/M reporting analytics.
Why This Topic Matters
Understanding differences in E/M utilization by provider type helps readers interpret claims data trends, compare billing patterns across years, and evaluate whether higher-level visit reporting is changing in a meaningful way. The article also provides context for organizations monitoring claims performance and denial experience.
Article Sections
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Summary
An overview of the analysis, its data source, and the broad comparison being made across provider types and visit categories.
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Breakdown
A closer look at how the comparison was organized for different visit groups and how the trends are framed over the study period.
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Takeaways
A brief discussion of the overall trend pattern and the reported denial-rate comparison for the higher-level visit group.
What You Will Learn
- How the article compares E/M utilization patterns between non-physician practitioners and physicians
- How the analysis distinguishes new patient and established patient visit trends
- What general claims-data and denial-rate themes are highlighted in the benchmark review
- How provider-type differences can affect interpretation of E/M reporting patterns
Who Should Read This
- Medical coders
- Coding auditors
- Revenue cycle staff
- Practice managers
- Billing compliance teams
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