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Benchmark of the Week
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.
The number of office E/M visits performed via telehealth spiked in April 2020, a sign that medical practices around the country took advantage of the relaxed rules for telehealth services that went into effect March 1, 2020.
The financial fallout of the COVID-19 pandemic continued well into 2021, and a return to normal spending levels doesn’t have a clear timeline, according to new research.
Use Medicare’s average per-patient payment for all E/M visits in your state as the starting point for your internal review of E/M claims to see how your payments compare to those of your peers in the same area.
You can expect big pay gains for chronic care management (CCM) codes in 2022, but that’s not the only service in line for a reimbursement surge. By strict dollar gains, the biggest winner for services in the non-facility setting is monthly end-stage renal disease service code 90954, with fees up $206 year to year.


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