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Benchmark of the Week
02/27/2017

Some states took home outsize portions of the total revenue tied to two advance care planning codes — 99497 and 99498 — over the first six months of 2016.

02/20/2017
Your chance of a denied claim goes up when you bill codes with modifier 59 (Distinct procedural service). In 2015, the most recent year available for Medicare claims data, claims with modifier 59 had a 19% denial rate versus a 16% denial rate without it. But that average fluctuates depending on specialty — and each of those specialties has its own highly denied codes when billed with 59.
02/13/2017

Firm up your ICD-10 coding when your patient encounters are related to essential hypertension, immunization encounters, general adult and pediatric visits and other diagnoses tied to mass denials.

02/06/2017
The ICD-10 codes reported most frequently to a major clearinghouse are pretty much what you’d expect — but their denial rates are much worse when they’re claimed as secondary diagnoses than when they’re claimed as the primary.
01/30/2017
Practices may be in for a steep challenge with the new non-face-to-face prolonged service codes (99358, 99359) this year if the billing sheets on previously available prolonged services are any indication.
01/23/2017
The list of Part B services with the most improper payments estimated by CMS for 2016 includes some of your most-billed services, according to data from the Comprehensive Error Rate Testing (CERT) program and other sources and published annually in the Medicare Fee-for-Service Improper Payments Report. Note that failure to establish medical necessity isn’t usually a factor; the mistake is more likely due to a coding error or a shortfall in documentation.
01/16/2017
Some specialty groups may want to take a closer look at their coding and billing processes for office visit codes 99201-99215 after a new report from CMS details more than a billion-dollar blunder.
01/09/2017
At first glance, it looks like not much has changed in denials for the 10 codes most often used with modifier 25 (Significantly, separately identifiable E/M service) over the past three years. As you can see in the chart, it’s mostly a matter of a point here, a point there.
01/02/2017

The competition for a limited amount of incentive dollars tied to the merit-based incentive payment system (MIPS) may be fierce in 2017, as nearly two in five respondents to a recent medical practice survey said they would report multiple measures during the 2017 transition year.

12/19/2016
Most codes that are frequently used with modifier 59 (Distinct separate service) have reasonable denial rates, but watch out for a few that seem to give providers trouble.

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