decisionhealth Newsletters, Part B News - 2017 Issue 4 (April)
Rates at MAC making big E/M changes similar to rest of U.S.
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Article Overview
This article examines Medicare Part B claims data to compare evaluation and management denial patterns in National Government Services’ jurisdiction with national trends. It is aimed at coders, billing professionals, and compliance staff who track Medicare contractor behavior and policy changes. The discussion focuses on broad E/M utilization and denial-rate patterns, regional variation, and why changes by one MAC may matter beyond that contractor’s service area.
Why This Topic Matters
Understanding contractor-level denial patterns can help organizations monitor whether local Medicare policy changes are isolated or may signal broader shifts. The article is relevant for practices that bill office visit E/M services and for teams watching CMS, MAC, and oversight activity.
What You Will Learn
- How E/M denial rates compare between one Medicare contractor jurisdiction and national Medicare data.
- Why regional variation in Medicare claims outcomes can matter to billing and compliance teams.
- How changes by a Medicare administrative contractor may relate to broader Medicare oversight activity.
- What Medicare claims data can suggest about stability and variability in office visit E/M denials.
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Revenue cycle professionals
- Compliance officers
- Healthcare administrators
- Physician practice managers
Codes Discussed
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