decisionhealth Newsletters, Part B News - 2014 Issue 9 (September)
Primary care billing more 99214, fewer 99213 and 99215 claims, data show
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Article Overview
This piece examines primary care evaluation and management billing trends using Medicare claims data, with attention to how established-patient office visit patterns compare across common service levels and how those patterns may attract audit scrutiny. It also references Medicare administrative contractor review activity and is relevant to internal medicine, family practice, coding compliance, and audit preparation.
Why This Topic Matters
Understanding utilization patterns for common office visit levels can help practices compare their own billing mix against national data and recognize when their claims profile may stand out. The article is also useful for monitoring payer review activity that may affect primary care documentation and billing compliance.
What You Will Learn
- How Medicare claims data are used to describe primary care E/M billing patterns
- Why common established-patient office visit levels can draw audit attention
- How payer review activity may affect primary care billing oversight
- What the article suggests about comparing a practice’s claim distribution to national benchmarks
Who Should Read This
- Internal medicine practices
- Family practice practices
- Medical coders
- Coding auditors
- Compliance staff
- Revenue cycle staff
Codes Discussed
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