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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 practices. It is important to monitor the allowables offered by each insurance carrier and to compare them with Medicare reimbursements. In the example shown in the figure, insurance carrier B consistently pays less than Medicare.

You should monitor your reimbursement 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 is an otolaryngologist in private practice in Indianapolis; sisenberg@good4docs.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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