DecisionHealth, DecisionHealth - 2011 Issue 8 (August)

Benchmark of the Week: Outpatient vs. inpatient E/M denials, 2009

Twice as many E/M codes are billed in the outpatient setting than inpatient, but the average denial rate is higher in the outpatient setting. This chart compares the E/M codes on a level-by-level basis in the two settings to examine where the denials are happening. NOTE: The “outpatient” setting is a combination of CMS claims data for place of service (POS) codes 11 (office) and 22 (outpatient hospital), while the “inpatient” setting is a combination of POS codes 21 (inpatient hospital) and 23 (emergency room).

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