Home | News & Analysis
Benchmark of the Week
As mentioned in our patient records story, there’s been a slow, steady climb in U.S. patients’ willingness to access their medical records. But the climb has been slower for some groups than others.

Practices that opt to partake in the Primary Care First delivery model that’s launching in 2020 will greet a hybrid payment model that combines two revenue sources: per-encounter fees and quarterly, population-based payments (see story, p. 1).

You may be surprised to learn that the place of service (POS) with the most-claimed code under Medicare would be 12 (home) rather than 11 (office) or 21 (inpatient hospital). But that’s where the lion’s share of Medicare’s biggest code is billed. And the number of services claimed for home overall stretches into 10 figures.
Beyond normal salary figures, the nation’s physicians and teaching hospitals reaped more than $8 billion in payments in 2017 from companies such as drugmakers and device manufacturers, according to data from the CMS-operated Open Payments program.
It’s a common joke that medical offices are all that’s keeping the fax machine industry alive. But clinging to that particular outmoded telecommunications tool is not the only way the medical practice business is behind the curve electronically. InstaMed’s 2018 Trends in Healthcare Payments report, which surveyed providers, payers and patients, suggests that patients want to pay their physician practice bills online but some may not be doing so because the practices aren’t pushing it.
Utilization of 77401 (Radiation treatment delivery, superficial and/or ortho voltage, per day) has been skyrocketing in recent years but CMS’ other radiation treatment codes have been going the other way.
Cardiologists, internal medicine providers and nephrologists are the most likely specialty groups to report a series of ambulatory blood-pressure monitoring codes that, ultimately, don’t get much attention.
Looking at Part B denial rates for modifiers 52 (Reduced services) or 53 (Discontinued procedure), it appears easier to get contractors to buy your reasons for stopping a procedure than your reasons for curtailing it, according to claims data from 2017, the most recent available.

Select few specialists, most notably ophthalmologists, report the bulk of procedural services with modifier 54 (Surgical care only), which denotes the work tied to the pre-operative and intraoperative pieces of the surgical puzzle.

Denial rates for the most popular screening and counseling codes for depression and alcohol and substance abuse are not great, and in one case forbidding. Make sure you get the little things right on your claims.


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