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Benchmark of the Week
03/27/2017

You may not find the X-factor you need for getting your claims through with CMS’ quartet of X modifiers if new reporting numbers from Medicare tell us anything. However, in some cases you’ll find extra motivation – read: lower denial rates – to get more X modifiers on your radar.

03/20/2017
If you haven’t been using X modifiers because you’re afraid it will increase denials, you may be surprised by their actual denial rates.
03/13/2017

When it comes to billing transitional care management (TCM) codes 99495 and 99496, it appears practice truly does make perfect — or something close. Following some early hiccups, practices netted more than $103 million in reimbursement for TCM claims in 2015, the latest year of available Medicare claims data.

03/06/2017
The historical benchmarks that will be used to determine quality measure scores sometimes can be deceiving. These tables, which use only the claims-based reporting benchmarks for process measures, give some idea of how you can find a “sweet spot” for your own reporting.
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.

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