Part B News | Benchmark of the Week

QPP report shows MIPS sagging, Advanced APMs lifting

06/26/2023

The latest Quality Payment Program (QPP) Experience Report, released on June 12, showed the number of eligible providers in MIPS declined, though Advanced APM participants rose. And as usual nearly everyone escaped a penalty, though bonuses remain low.

Top codes with modifier 25: ED, eye exams, critical care stand out

06/19/2023

by: Richard Scott

Look to emergency department visits, eye exams and critical care services if you’re running an assessment of claims involving the sometimes-tricky rules for modifier 25 (Significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of the procedure or other service). Outside of office visits, those services topped the list of most-used code combinations with the same-day E/M modifier.

After changes, FNA with ultrasound, tangential biopsy dominated

06/12/2023

by: Julia Kyles, CPC

The codes for fine needle aspiration (FNA) and biopsy of skin lesions received a major update in the 2019 CPT manual. The update revised FNA code 10021 to become a primary code for a new add-on code and replaced three outgoing codes with 16 new codes.

Pandemic cut most nursing facility E/M, but 99309 looks strong

06/05/2023

by: Roy Edroso

Notwithstanding the pandemic waivers of the three-day rule, nursing facility E/M and discharge codes, used by skilled nursing facilities, mostly took a hit during the public health emergency (PHE). As noted by the Kaiser Family Foundation, there was a decline in SNF admissions during that period, though the length of SNF stays and spending increased.

Revenue up despite claims depression for psych, diagnostic codes

05/22/2023

by: Richard Scott

While mental health surfaced as a big topic during the COVID-19 crisis, most psychiatric evaluation and psychotherapy services didn’t see a major boost in claims. Nearly all saw a dip in utilization between 2019 and 2021, although the lone outlier grew enough, abetted by rate increases, that payments jumped more than $66 million.

A year of HIPAA breach data highlights the current threats to PHI

05/15/2023

by: Julia Kyles, CPC

Outside attempts to steal protected health information (PHI), such as ransomware attacks, dominate the headlines, but internal mistakes continue to trigger breaches involving at least 500 patients. Any provider who experiences a breach of that size must file a report with HHS that will be posted on the so-called HIPAA “wall of shame,” notify the affected patients, make a public announcement, take steps to mitigate harm to the patients and, often, weather the bad press that follows.

X marks the spot: XS, XU modifiers outclass 59 in denial rate battle

05/01/2023

by: Richard Scott

In a head-to-head showdown, the series of X modifiers that CMS permits for two or more procedures on the same date of service turned in favorable performances compared to modifier 59 (Distinct procedural service), even as total X-modifier claims came in low.

Primary care won CCM, but other specialties rose up for PCM codes

04/24/2023

by: Julia Kyles, CPC

Primary care providers dominated the top five slots in total reporting of traditional chronic care management (CCM) involving at least two chronic conditions. However, a wide range of specialties rose to the top when CMS introduced two codes for the management of one complex chronic condition, also known as principal care management (PCM).

Retirement crunch: Docs cite burnout, cash; administrators don’t see it

04/10/2023

by: Richard Scott

Amid reports of a potential retirement crisis among medical groups, administrators are underestimating the reason that many physicians are heading for the exits. Physicians indicate that burnout and financial concerns are two of the leading reasons to hang it up, yet few administrators see it that way.

Denials quadrupled after hospital outpatient prior-auth policy took hold

04/03/2023

by: Julia Kyles, CPC

Denials spiked for a variety of services performed in the hospital outpatient setting even as utilization tumbled, and a Medicare prior authorization policy may be one reason behind the change.

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