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Benchmark of the Week
You’ll find lucrative pay gains among a series of chronic care management (CCM) services in CY2022, as CMS seeks to expand their use. Yet not all fee changes are as propitious. Dozens of codes are taking fee hits, including a series of gastrointestinal services.
The numbers contained in CMS’ short list of high-volume codes are even less rosy than this year’s earlier proposal, with harsher payment cuts coming in CY 2022.
While the 4% cut to the 2022 conversion factor is coming for all specialties, the impact of relative value unit (RVU) changes harbors its own outlook – fluctuating from a 6% gain for diagnostic testing facility to a -5% drop for interventional radiology and vascular surgery.
Get ready to sharpen your claims billing when the calendar flips to 2022 by adapting to a slate of CPT code revisions. Of the hundreds of CPT code changes taking effect Jan. 1, you’ll find 93 revised codes, many of which are impacting oft-reported services.
Most virtual encounters during the COVID-induced telehealth spike involved patients who had an established relationship with a provider, and that detail may influence federal policymaking on the future coverage of tech-enabled visits, according to an OIG analysis released Oct. 20.
If you’ve been doing better on Medicare appeals lately, you’re part of a trend. Between 2013 and 2020, the overall rate of success for providers and suppliers on redeterminations, the first level of formal Medicare appeals on claims denials, rose from 46.5% to 55% at Part B Medicare administrative contractors (MACs). And Part B durable medical equipment (DME) claimants did even better.
With the annual CPT code release now out, you’ll find hundreds of new, revised and deleted codes coming your way (see related story, p. 1). With numerous codes expiring, prepare to shift to alternative options for dozens of services and procedures in 2022.
It looks as if providers have cut way back on their use of modifier 78 (Unplanned return to the operating room by the same physician fol-lowing initial procedure for a related procedure during the postoperative period). In 2019, the modifier appeared on a mere 94,255 claims, a major drop from 2015, when it was claimed more than 531,000 times.
The manipulation of chart reviews and the vendor-led increase of in-home health risk assessments (HRA) may be inflating diagnosis coding levels, and be warned: The OIG and other federal groups are closely monitoring the activity.
The latest Medicare enrollment numbers show that while Medicare Advantage continues to gain a share of covered patients, traditional Medicare is fading fast.


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