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Benchmark of the Week

Now that the scores are in, you can assess the winners and losers of the final 2019 Medicare physician fee schedule, which increased the payment rates of some oft-used codes and slashed rates on others.


Denial rates for codes related to magnetic resonance imaging (MRI) under Medicare are not terrible, but watch out for a few high-rejection codes and make sure you’re keeping up on CMS and contractor news and changes on the ones you use.

When it comes to E/M payments, you’ll enter a business-as-usual cycle on Jan. 1 after CMS opted to delay its proposed sweeping changes for two years. But with a vast array of revisions on the books for 2021, it’s not too early to glimpse the financial outcomes of the single-pay rates and other changes looming ahead.
The growing wave of Medicare Advantage (MA) plans may increase the administrative time your practice spends chasing down prior authorizations, as the bulk of MA patients – about 80% – are in a plan that requires one for at least some services, according to new analysis from Kaiser Family Foundation (KFF).
The growth in Medicare Advantage plans is impressive, but the penetration of those plans into heretofore underserved areas may be even more so, on the evidence of the Kaiser Family Foundation’s recent issue brief “Medicare Advantage 2019 Spotlight: First Look” by Gretchen Jacobson, Anthony Damico and Tricia Neuman.

Experts say it’s still a tricky and underutilized service, but the numbers behind the annual wellness visit (AWV) wouldn’t make you think so

As year two of the Quality Payment Program (QPP) winds down, practices report ongoing challenges with CMS’ full-bore pivot to value-based care and dissatisfaction with specific elements of the program, according to a survey from the Medical Group Management Association (MGMA) in Englewood, Colo.
The provider types that tend to make the most use of the 10 office E/M codes (99201-99215) are a mixed bag of specialists and primary care providers, but the big news in the most recent Medicare utilization numbers from 2017 is the continuing rise in use of the codes by nurse practitioners (NPs) and physician assistants (PAs).

Claims for advance care planning codes 99497-99498 increased significantly between 2016 and 2017, topping out at nearly 1.3 million services collectively, according to the most recent Medicare claims data.

Providers don’t like to use unlisted codes if they can help it, and no wonder — the denial rates are ridiculous.


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