Part B News | Benchmark of the Week

Injections, E/M hospital visits top list of locum tenens services

09/11/2023

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.

Map out state-level data for AWVs to see where your practice stands

08/21/2023

by: Julia Kyles, CPC

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.

E/M fee preview: Care management service tops list with 26% pay jump

08/14/2023

by: Richard Scott and Laura Evans, CPC

A number of services in the E/M category are on track for big pay gains in CY 2024, led by behavioral health care management (99484), set for a 26% jump to $54 per service, and joined by two prolonged services codes (99415, 99416).

Remote BPCI codes, E/M services big gainers in proposed PFS fee dollars

08/07/2023

by: Roy Edroso; data reporting by Laura Evans, CPC

Among the services for which CMS proposes to raise reimbursement by the largest percentage in CY 2024, there’s a thread of E/M codes that meet two of CMS’ recent areas of focus – remote services and bundled care.

2024 projections: 10 specialties up at least 2% in RVUs, 18 down

07/24/2023

by: Richard Scott

A glimpse ahead to 2024 payment rates reveals an up-and-down outlook for physician specialties and their allowable charges. Setting the bar at a 2% gain or loss, 10 specialties find themselves on the positive side of the ledger in combined relative value unit (RVU) impact, while 18 specialties are projected for cuts.

Claims with OR-return modifier 78 drop 25% in one year

07/17/2023

by: Roy Edroso

The years-long decline in claims with modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period) was accelerated by the pandemic in 2020. This downward trend appears to have continued in 2021: The total number of claims made with 78 dropped precipitously, from 87,826 in 2020 to 65,857 in 2021, a decline of 25%.

Practices turned to telehealth for 40% of psych visits after CMS waivers

07/10/2023

by: Richard Scott

Auditors are keying in on psychotherapy services delivered via telehealth, and Medicare claims show that they will have a massive trove of data to investigate. In 2021, as the COVID crisis continued to shutter offices, providers routinely turned to telehealth to deliver behavioral health care to patients after CMS granted waivers, capturing some 40% of visits on the most-used services.

Physicians score EHR systems highly, but many ding chart time

07/03/2023

by: Julia Kyles, CPC

More than 60% of physicians are “very” or “somewhat” satisfied with their electronic health record (EHR) systems and described documenting clinical care – whether they use a paper or EHR system – as “very” or “somewhat” easy, according to analysis of the last three National EHR Surveys, which contain data for 2018, 2019 and 2021.

QPP report shows MIPS sagging, Advanced APMs lifting

06/26/2023

by: Roy Edroso

The latest Quality Payment Program (QPP) Experience Report, released on June 12, showed the number of eligible providers in MIPS declined, though Advanced APM participants rose. And as usual nearly everyone escaped a penalty, though bonuses remain low.

Top codes with modifier 25: ED, eye exams, critical care stand out

06/19/2023

by: Richard Scott

Look to emergency department visits, eye exams and critical care services if you’re running an assessment of claims involving the sometimes-tricky rules for modifier 25 (Significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of the procedure or other service). Outside of office visits, those services topped the list of most-used code combinations with the same-day E/M modifier.

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