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Benchmark of the Week
More groups opted into the Medicare Shared Savings Program (MSSP) in 2022 than they did the previous year, ending a one-year slide that had softened enrollment rates in the national value-based model.
Behavioral health codes cleared for phone use in 2020 did not gain much in utilization compared to previous years, but providers were largely successful when reporting them.
The audio-only option that CMS cleared for certain E/M services during the COVID-19 public health emergency (PHE) was a boon for medical practices, according to a Part B News analysis of Medicare claims data. While utilization of E/M services that did not have an audio-only option fell 14% between 2019 and 2020, services that were audio-eligible faced just a 3% dip – a considerable win in an overall depressed claims era.
The long-standing challenge of the prior authorization (PA) process, which providers have cited as an impediment to care for years, has not become easier to navigate and still puts patients at harm, industry surveys indicate.
While many phone and online services jumped in 2020, transitional care management (TCM) hit a huge snag in utilization. However, despite the lower number of claims, providers had less trouble than ever getting their claims accepted.
The rapid rise of physician associates (PA) has the profession poised to play an increasingly vital role in health care delivery in the coming years, and billing rules are freeing up opportunities like direct pay (PBN 2/28/22). A look at employment data shows that some states are ahead of the curve in hiring trends.
The increased Medicare billing of the leading non-physician providers – nurse practitioners (NP) and physician associates (PA) – is buoyed by E/M claims, given that these practitioners have become a major part of patient intake in practices. But their share of procedure codes also is increasing.
The use of prolonged services had their ups and downs in recent years, showing sharp swings between 2018 and 2020, and the COVID-19 crisis did not appear to have a negative impact on all codes.
The toll of the COVID pandemic caused reduced services across many types of patient encounters in 2020, but critical care services didn’t suffer. They expanded. Perhaps due to the health impact of the COVID scourge, practices increased revenue for critical care encounters (99291-99292) by more than 10% in 2020 compared to the year before.
The most used preventive service codes under Medicare in 2020, like most other codes, suffered a big utilization drop versus the previous pre-COVID year. Yet the biggest earner among them, the subsequent annual wellness visit (AWV), performed relatively well.


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