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Benchmark of the Week
12/14/2020
It’s a topsy-turvy fee outlook in 2021, as medical practices are projected to see wild fluctuations in Part B charges in the new year. With specialty-specific gains reaching as high as 16% – and losses also reaching double digits – your billing patterns are likely to tell how your Medicare charges will fare.
12/07/2020
Considering its stringent requirements, you may expect claims with modifier 24 (Unrelated E/M service during a postoperative period) to see a lot of denials. But their rates are actually very low, especially compared to where they were four years earlier.
11/23/2020
The critical care code set may be small in size, consisting of two CPT codes (99291, 99292), but it packs a wallop when it comes to provider revenue. In 2019, practices surpassed the $1 billion mark in payments tied to the two codes.
11/16/2020
CMS released its Part B claims numbers for 2019 on Nov. 5, and the yearly numbers show nearly everything growing except two areas: denial rates and E/M utilization.
11/09/2020
Check the time and other possible billing hazards for advance care planning (ACP) claims. The two ACP codes (99497, 99498) show an average denial rate of 19% since Medicare started covering the service, which may be a sign that practices are making easy-to-avoid mistakes for the two codes.
11/02/2020
Provider payments for two psychiatric diagnostic evaluation codes (90791, 90792) maintained steady growth in recent years, returning more than $140 million in fees in 2018, the latest year of available Medicare claims data.
10/26/2020
Providers seem to vastly favor using modifier 25 (Significant, separately identifiable E/M service) in mid-level established patient visits over any other. But it gets a workout with other codes as well – some of them inappropriately.
10/19/2020
Providers have been slow to make an entrance into the Medicare Diabetes Prevention Program (MDPP), which offers a series of payments to fight the rising rates of type 2 diabetes.
10/12/2020
It’s still a traditional-Medicare world, but if trends continue, it won’t be for long.
10/05/2020
The number of office E/M codes that nurse practitioners (NP) are reporting under Medicare Part B has been on a significant upswing in recent years. Total claims for their most-billed office code, 99214, are up 114% from 2014 to 2018.

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