Outpatient Key Takeaway’s:
- Nationally, New Patient Evaluation & Management codes (CPT 99302-99205) were commercially reimbursed 110% of Medicare. While Diagnostic Colonoscopy (CPT 45378) are reimbursed at 161% of Medicare.
- 25 states have average commercial reimbursement below average Medicare rates.
Commercial patients are a key component to a health systems financial health. Attracting, engaging and retaining commercial patients is imperative for your health system to thrive. Unfortunately, the number of commercially insured patients inexorably decreases, with the ~10,000 citizens who become Medicare eligible every day being “replaced” by the 10,388 average daily births, the majority of which are financed by Medicaid.,, Understanding the commercial patients in your market will give you an advantage during payer negotiations and patient outreach.