decisionhealth Newsletters, Part B News - 2010 Issue 3 (March)
NPP Benchmark: E/M vs. consult denial rates of NPPs and physicians
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Article Overview
This benchmarking article examines how denial rates differ between evaluation and management services and consult services for non-physician practitioners and physicians under Medicare. It is intended for coders, billing teams, and practice leaders who want to understand utilization and denial patterns, compare provider groups, and assess how broader consult-policy changes may affect reimbursement trends. The article discusses aggregate denial data, specialty group comparisons, and general implications for practices without providing code-selection instructions.
Why This Topic Matters
It helps readers gauge whether consult-elimination policy changes are likely to have a meaningful payment impact for NPP-heavy practices compared with physician practices, based on historical denial patterns and service mix.
Article Sections
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Summary
Introduces the article’s focus on denial-rate comparisons between evaluation and management services and consult services, along with the relevance of consult elimination for different provider groups.
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Breakdown
Reviews aggregate denial patterns for non-physician practitioners and contrasts them with broad physician group patterns across Medicare-billed services.
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Takeaways
Discusses the broad implications of the denial-rate comparison for practices and the likely scale of any payment effect from consult elimination.
What You Will Learn
- How the article frames denial-rate comparisons between evaluation and management and consult services
- How non-physician practitioner patterns are compared with physician group patterns
- What general factors are highlighted as relevant to consult-elimination impact
- How the article groups specialties and summarizes aggregate Medicare utilization
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Practice managers
- Compliance teams
- Revenue cycle analysts
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