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Benchmark of the Week
When delivering common injection and procedure services, providers tend to veer to the right side of the body more often than the left. That’s what an inspection of claims with RT (Right side) and LT (Left side) modifiers reveals.

Auditors emphasize the amount of improper payments attributed to common venipuncture code 36415 with bundled codes in 2018. But it’s also worth noting that the codes with which 36415 may have been improperly claimed generally pay more — and it’s really not worth potentially gumming up your claims on those codes for a small extra payment on a blood draw.

Alert your billing staff to several dozen code bundles that will restrict a range of same-day services, including some allograft procedures, when the latest Correct Coding Initiative (CCI) edits take effect Oct. 1.
Practices are expecting to take a hit on cataract surgery fees in 2020 based on pay rates announced in the proposed 2020 Medicare physician fee schedule, and that could lead to a drain of hundreds of millions of dollars nationally.

If the codes CMS just cleared to be billed with transitional care management (TCM) in 2020 see a lift in utilization, you can be pretty confident that clearance will be the reason for the change. That's because, as you can see by this chart, utilization of these codes over the past five years has been very consistent — and mostly low — even when payment terms have been altered.

Cue the drum roll: After analyzing the numbers and poring over the inputs, a Part B News analysis turned up some big winners and unfortunate losers from the proposed 2020 Medicare physician fee schedule.

Readers of the 2020 proposed Medicare physician fee schedule (PFS) are probably trying to figure out how the new E/M rules will affect their reimbursement. But CMS has already looked at last year's volume and mix of services provided by each provider specialty and assessed the effect of the proposed fee schedule on them.

Practices are seeing a downward trend in revenue for cerumen-removal services even as the total number of claims was buoyed in recent years with the arrival of CPT code 69209 (Removal impacted cerumen using irrigation/lavage, unilateral).

The recent discussion of ways to hold down drug pricing is needed, as you can see by the latest quarterly average sales price (ASP) update issued by CMS. The ASP update shows the upper limit on prices to which providers will be allowed to add a surcharge of 6% in the 3rd quarter of 2019.

Practices that run diagnostic tests and independent labs fared pretty well with a range of panels associated with millions of dollars in revenue in recent years. But a few tests, including vitamin D and hemoglobin assays, continue to perplex the billing department.


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