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Benchmark of the Week
The final specialty-based fee projections look a lot like the ones CMS proposed several months ago. Setting the threshold at positive or negative 2%, a total of 10 specialties are on pace to see fee gains in 2024, while 18 are in the red.
All but one code in the series of six initial (99221-99223) and subsequent (99231-99233) hospital care encounter codes saw a claims drop-off in the three-year period from 2020-2022, and providers saw a decline in total payments over the same span.
Wondering what gets a new physician to join your practice? No surprise, it’s usually about money. However, you may find the factors that come a close second and third, and that convince doctors to stay with a practice, more unexpected.
Emergency medicine providers are the top team players, according to analysis of Medicare data for modifier FS (Split [or shared] evaluation and management visit).
Two years after the pandemic dealt a blow to the health care ecosystem, one key marker of the system’s vitality – routine office visits – had largely not recovered. The most-reported office visits, reflected in codes 99213 and 99214, sat at a depressed rate of -23% and -8%, respectively, in the four-year period from 2019 to 2022.
Based on just-released Medicare Part B claims data, the 15 most-billed codes in 2022 were similar to those in 2021 and 2020, with one major COVID-related exception. But overall Medicare utilization and reimbursement took a big hit compared to prior years.
Coders turn to left- and right-side modifiers millions of times per year, and they are most likely to deploy the anatomic modifiers LT (Left side) and RT (Right side) following encounters with patients suffering from osteoarthritis.
Take a look at proposed physician payments for new services: CMS included fees for 43 new CPT codes and seven HCPCS G codes in the proposed 2024 Medicare physician fee schedule.
When subbing in a physician under locum tenens arrangements, the situation often involves diagnostic radiology services and cancer care. Among E/M services, hospital visits are more likely to involve a substitute physician than office visits.
Check your claims for subsequent annual wellness visits (AWV) (G0439) against state level data. You can mine the information to provide a more nuanced picture of your billing data, capture a peek into the services your competitors provide and alert you to coding patterns that warrant a closer look.


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