Part B News | Benchmark of the Week

Benchmark of the Week: Diagnostic colonoscopy denial rates, utilization vs. screenings, 2010-2011

02/14/2013

This table and chart depict billing and denial trends for colon cancer screening and diagnostic services from 2010 to 2011. Denial rates overall remained low, less than 10%, and diagnostic colonoscopies were by far the top-billed services for both years followed by fecal occult screenings (G0328).

Benchmark: Claims denials with ALF, SNF place-of-service codes, 2010-2011

02/07/2013

by: Lauren C. Williams

The charts below evaluate how providers are billing Part B services in skilled nursing facilities (SNFs) and assisted living facilities (ALFs). The graphs show denial rates above 5% for top utilized codes billed with place-of-service (POS) code 31 for SNFs and POS 13 for ALFs.

Benchmark of the Week: Top-denied services billed with mods. 57 and 25

01/31/2013

by: Lauren Williams

These two charts evaluate how providers bill E/Ms linked to surgery and additional procedures.

Benchmark of the Week: Top utilization changes by specialty, 2010-2011

01/28/2013

by: Lauren C. Williams

These two charts show the top 13 specialties with the greatest utilization growth and decline from 2010 to 2011. Note: The bars in the graphs represent the percent change in utilization or how many claims were billed over those two years and do not reflect total number of claims billed. Also, specialties that billed fewer than 1 million claims a year were excluded from the analysis.

Benchmark of the Week: Top denied preventive services, 2011 vs. 2010

01/18/2013

This graph compares the top 10 most-utilized preventive services that saw the highest denial rates from 2010 and 2011, based on an analysis of CMS claims data.

Benchmark of the Week: 10 highest and lowest modifier denials, 2010-2011

01/07/2013

by: Ben Penn

These charts examine a total of 20 modifiers, 10 of which had some of the highest denial rates in 2011 and 10 which had some of the lowest, comparing their 2011 rates with 2010. Modifiers with a total service count of less than 100,000 were excluded from the graphs, which were based on a Part B News analysis of the latest Medicare claims data available.

Benchmark of the Week: Established patient upper-level E/M denial rates by specialty

12/24/2012

by: Ben Penn

These charts show established patient upper-level E/M denial rates from 2010 and 2011, organized by the 12 specialties that bill initial patient E/M office visits most frequently. Based on a Part B News analysis of the latest Medicare claims data available, 99214 denial rates from 2010 and 2011 for each specialty are displayed in the top chart and 99215 denial rates for those years are in the bottom chart. For a look at the same data but for initial patient E/M visits, go to PBN 12/17/12.

Benchmark of the Week: Initial patient upper-level E/M denial rates by specialty

12/17/2012

by: Ben Penn

These charts show initial patient upper-level E/M denial rates from 2010 and 2011, organized by the 12 specialties that bill initial patient E/M office visits most frequently. Based on a Part B News analysis of the latest Medicare claims data available, 99205 denial rates from 2010 and 2011 for each specialty are displayed in the top chart and 99204 denial rates for those years are in the bottom chart.

Benchmark of the Week: Discharge management denial rates, 99238-99239

12/10/2012

by: Ben Penn

This chart displays the hospital discharge management codes’ denial rates for the 18 physician specialties that used the codes most frequently in 2011. Based on a Part B News analysis of the latest Medicare claims data, the denial rates for both 99238 (30 minutes or less) and 99239 (More than 30 minutes) are presented for each specialty, presented below in alphabetical order.

Benchmark of the Week: Top 10 high-growth, high-denial codes, 2010-2011

12/03/2012

by: Ben Penn

A variety of procedures top the list of high-denial codes that also saw a big jump in utilization from 2010 to 2011, the latest year for which CMS claims data is available. Note: Lab codes and supply codes were excluded from analysis, as were codes with low utilization, low denial rates and/or low utilization growth over the one-year period.

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