Home | News & Analysis
Benchmark of the Week
Individual clinicians and practices continued to take part in the Quality Payment Program (QPP) during the first year of the COVID-19 pandemic. However, there were shifts in how many participants met or exceeded performance thresholds in 2020 compared to 2019, according to a CMS fact sheet.
While some of your patients will find relief under the Inflation Reduction Act (IRA), their financial contributions to coverage continue to rise, according to CMS’ most recent FastFacts program data. Federal health care programs continue to grow, as well, although none of the Medicare programs are picking up members as quickly as Medicaid.
With big changes coming to the inpatient E/M code family in 2023, the fees associated with facility codes 99221-99223 and 99231-99233 are also in flux. Initial visit fees are down, while subsequent encounters are on the rise.
Nurse practitioners (NP) will find it easier to report visits in the domiciliary and home settings when the next E/M update goes into effect Jan. 1, 2023. The update will delete the code family for domiciliary, rest home and custodial care services (99324-99337) and fold the services into the home services family (99341-99350). That code family will be renamed “home or residence services.”
The almost 4% proposed cut to the 2023 conversion factor would, if finalized, have a powerful negative effect on many of the most-used Part B procedure and E/M codes. Factoring in changing relative value units (RVU) reveals some big winners and losers on a per-service basis.
Physician practices are facing a 4% cut to the conversion factor in CY 2023, and the fee losses are evident when looking at a list of high-volume procedures and services. For non-facility rates, only two of the nearly two dozen services on this list will see larger payments in the new year, according to a review of data CMS shared as an addendum file to the proposed 2023 Medicare physician fee schedule.
As providers brace for a nearly 4% cut to the 2023 conversion factor, the impact of relative value unit (RVU) changes on specialties is projected to fluctuate from a 5% gain for infectious disease to a -4% drop for interventional radiology.
The next E/M update will affect 69 codes from five code families and will go live in less than six months. Part B News analysis of Medicare Part B claims for 2019 and 2020 reveals that frequently billed E/M services in three of the impacted code families — inpatient hospital, emergency department and nursing facility services — exceeded several office/other outpatient codes.
Use of modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period) has been in decline for some time. In 2020, as COVID depressed utilization across the board, 78’s claim numbers continued to decline — while its denial rates soared.
Practices were far more likely to report a right- or left-side service over a bilateral procedure in 2020, although they faced a bit more resistance in getting their side-specific claims paid than before.


User Name:
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.
Back to top