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Monitoring reimbursements for evaluation and management.



Evaluation and management (E&M) functions constitute a large percentage of the work performed in most otolaryngology otolaryngology
 or otorhinolaryngology

Medical specialty dealing with the ear, nose, and throat (see larynx, pharynx). The connection of these structures became known in the late 19th century.
 practices. It is important to monitor the allowables offered by each insurance carrier and to compare them with Medicare Medicare, national health insurance program in the United States for persons aged 65 and over and the disabled. It was established in 1965 with passage of the Social Security Amendments and is now run by the Centers for Medicare and Medicaid Services.  reimbursements. In the example shown in the figure, insurance carrier B consistently pays less than Medicare.

You should monitor your reimbursement Reimbursement

Payment made to someone for out-of-pocket expenses has incurred.
 for each E&M code and consult with an expert regarding a fee schedule analysis. If you identify a consistent trend of poor reimbursement from a particular carrier, you should consider dropping that particular plan. E&M codes are usually among the most frequently billed CPTs in otolaryngology practices.
Figure. In each case, carrier B's reimbursements is
lower than that provided by Medicare (MC).

Code     INS A    INS B    INS C    INS D

99202    42.00    38.52    43.12    44.65
99213    50.75    46.00    51.00    51.60
99214    78.30    64.00    75.21    78.03
99242    85.00    54.86    64.13    60.55
99243   102.10   105.00   111.82   131.35
99244   161.14   134.00   167.22   182.88
99245   209.35   128.99   207.32   233.74
99262    47.55    43.00    48.02    48.07

Code     INS E   MC PYMTS   2004 Fee

99202    60.71      41.65     105.00
99213    51.63      49.50      90.00
99214    78.19      78.07     130.00
99242    62.49      61.12     180.00
99243   114.32     114.13     215.00
99244   162.71     162.07     315.00
99245   212.03     209.70     105.00
99262    49.12     45.019     190.00


Dr. Isenberg Isenberg was a County of mediƦval Germany. It was a partition of the County of Altena, and was annexed to Limburg-Isenberg in 1242. Counts of Isenberg (1191 - 1242)
  • Eberhard II of Altena, count of Altena and Isenberg (born 1180, died 1209)
 is an otolaryngologist in private practice in Indianapolis Indianapolis (ĭn'dēənă`pəlĭs), city (1990 pop. 731,327), state capital and seat of Marion co., central Ind., on the White River; selected 1820 as the site of the state capital (which was moved there in 1825), inc. 1847. ; sisenberg@good4docs Short for documents or documentation. .com
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Title Annotation:Practice Management Clinic
Author:Isenberg, Steven F.
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Nov 1, 2004
Words:278
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