Part B News | Benchmark of the Week

Diabetes education services recover slightly; DSMT, MNT beat MDPP

01/09/2023

Despite much CMS fanfare, the Medicare Diabetes Prevention Program (MDPP), never very popular to begin with, continued its dismal utilization numbers in 2021. Medicare’s other, less heralded diabetes education services, diabetes self-management training (DSMT) and medical nutrition therapy (MNT), have done better, but still took a hit in the pandemic.

Practices to dial up denials, collections strategies to offset pay cuts

01/02/2023

by: Richard Scott

Practices are on the verge of stepping up their denials management strategies in 2023 as Medicare Part B rate cuts are expected to impact revenue. On the delivery side, most practices plan to continue their telehealth operations in the new year.

CMS’ prior authorization reform would reap $15B over 10 years

12/19/2022

by: Richard Scott

A CMS plan to streamline the prior authorization process for certain payers would slash the amount of time spent chasing approvals and save providers billions.

ACP codes return $142M for providers as billing climbs

12/12/2022

by: Richard Scott

Providers are increasingly likely to help patients navigate their advance directives and other pieces of the advance care planning (ACP) set of services, and reimbursement is climbing accordingly.\

With one exception, selected codes take big hit in 2023

12/05/2022

by: Roy Edroso

When Part B News looked at the “Impact on CY 2022 payment for selected procedures” that came with the physician fee schedule last year, there was not a single rate gainer among the 23 codes with non-facility rates. Flash forward to that list for 2023, and you’ll find that – with one significant exception – the situation is even worse.

Denials for prolonged codes hint at trouble for practices in the new year

11/21/2022

by: Julia Kyles, CPC

Practices will experience a spike in denials for prolonged services in 2023 if they aren’t prepared for the next round of coding updates. Medicare Part B claims data show that denials for prolonged services by physicians and qualified health care professionals (QHP) in the outpatient setting (99354 and 99355) increased from an average of 10% in 2020 to an average of 30% in 2021.

Most specialties projected to lose charges in 2023: Fee schedule

11/14/2022

by: Richard Scott

The number of specialties welcoming a boost to their allowed charges in 2023 is far outpaced by those facing projected cuts, according to relative value unit (RVU) revisions announced in the final 2023 Medicare physician fee schedule released Nov. 1.

Part B claims in 2021 inched up, but payment surged

11/07/2022

by: Roy Edroso

After stalled growth in 2020, practices lived through a modest recovery in utilization in 2021. For payments, however, it was a banner year.

After emergency medicine, PCPs and surgeons take over ER

10/31/2022

by: Julia Kyles, CPC

Thanks to popular media, the public may think that physicians and nurses who specialize in emergency medicine are the only providers who work in the emergency department. But the latest Medicare Part B data for emergency department E/M visits (99281-99285) reveals that members of any specialty can and do provide emergency department services.

Heaps of ‘after-hours’ codes reported, and all denied

10/24/2022

by: Richard Scott

Despite a non-payable status under Medicare, a series of six codes that reflect care provided during irregular or emergency hours garnered hundreds of thousands of claims – and returned zero dollars – in 2021.

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