Part B News | Benchmark of the Week

2022 saw historic drops in Part B utilization and payment; tests rise

10/09/2023

Based on just-released Medicare Part B claims data, the 15 most-billed codes in 2022 were similar to those in 2021 and 2020, with one major COVID-related exception. But overall Medicare utilization and reimbursement took a big hit compared to prior years.

Left side, right side: Providers go side-specific on injection, X-ray services

09/25/2023

by: Richard Scott

Coders turn to left- and right-side modifiers millions of times per year, and they are most likely to deploy the anatomic modifiers LT (Left side) and RT (Right side) following encounters with patients suffering from osteoarthritis.

CMS previews projected 2024 payments for 52 new, newly active codes

09/18/2023

by: Julia Kyles, CPC

Take a look at proposed physician payments for new services: CMS included fees for 43 new CPT codes and seven HCPCS G codes in the proposed 2024 Medicare physician fee schedule.

Injections, E/M hospital visits top list of locum tenens services

09/11/2023

by: Richard Scott

When subbing in a physician under locum tenens arrangements, the situation often involves diagnostic radiology services and cancer care. Among E/M services, hospital visits are more likely to involve a substitute physician than office visits.

Map out state-level data for AWVs to see where your practice stands

08/21/2023

by: Julia Kyles, CPC

Check your claims for subsequent annual wellness visits (AWV) (G0439) against state level data. You can mine the information to provide a more nuanced picture of your billing data, capture a peek into the services your competitors provide and alert you to coding patterns that warrant a closer look.

E/M fee preview: Care management service tops list with 26% pay jump

08/14/2023

by: Richard Scott and Laura Evans, CPC

A number of services in the E/M category are on track for big pay gains in CY 2024, led by behavioral health care management (99484), set for a 26% jump to $54 per service, and joined by two prolonged services codes (99415, 99416).

Remote BPCI codes, E/M services big gainers in proposed PFS fee dollars

08/07/2023

by: Roy Edroso; data reporting by Laura Evans, CPC

Among the services for which CMS proposes to raise reimbursement by the largest percentage in CY 2024, there’s a thread of E/M codes that meet two of CMS’ recent areas of focus – remote services and bundled care.

2024 projections: 10 specialties up at least 2% in RVUs, 18 down

07/24/2023

by: Richard Scott

A glimpse ahead to 2024 payment rates reveals an up-and-down outlook for physician specialties and their allowable charges. Setting the bar at a 2% gain or loss, 10 specialties find themselves on the positive side of the ledger in combined relative value unit (RVU) impact, while 18 specialties are projected for cuts.

Claims with OR-return modifier 78 drop 25% in one year

07/17/2023

by: Roy Edroso

The years-long decline in claims with modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period) was accelerated by the pandemic in 2020. This downward trend appears to have continued in 2021: The total number of claims made with 78 dropped precipitously, from 87,826 in 2020 to 65,857 in 2021, a decline of 25%.

Practices turned to telehealth for 40% of psych visits after CMS waivers

07/10/2023

by: Richard Scott

Auditors are keying in on psychotherapy services delivered via telehealth, and Medicare claims show that they will have a massive trove of data to investigate. In 2021, as the COVID crisis continued to shutter offices, providers routinely turned to telehealth to deliver behavioral health care to patients after CMS granted waivers, capturing some 40% of visits on the most-used services.

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