DecisionHealth, DecisionHealth - 2011 Issue 4 (April)

Benchmark of the Week: Primary care use of specialist codes, 2005-2009

This chart analyzes how primary care practices have branched out in terms of billing services typically billed by specialists over the last five years for which CMS claims data is available. Services are considered “specialist” when a non-primary care specialty or specialties are responsible for the majority of annual Medicare utilization. Denial rates are not shown, but the data is overwhelming that while primary care may be billing more of these specialist services than before, they don’t do so nearly as well as specialists.

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