Part B News | Benchmark of the Week

Survey shows Miss. tops for PCP, non-surgical specialist pay; D.C. lags

06/17/2024

The latest MGMA physician compensation report doesn’t just have financial figures for different practice types. It also looks at the top states and regions for compensation by different kinds of practitioner, some of which may be a surprise to you.

1 to 2 muscle trigger point injections fall 33% in 5 years

06/10/2024

by: Richard Scott

The rates of administering trigger point injections (TPI) have dropped dramatically in recent years, and providers have witnessed an associated revenue shortfall for the two primary TPI codes used for pain management.

QPP 2022: Clinicians at small practices preferred group reporting

06/03/2024

by: Julia Kyles, CPC

Nearly 60% of small practices used the group reporting option to participate in the 2022 Quality Payment Program (QPP), and nearly 45% of small practices that participated via group reporting received the small practice bonus, according to Part B News analysis of the 2022 QPP Public Use File (PUF), which contains the most recent data on QPP participation.

G0136 joins select group of codes cleared for use with modifier 33

05/20/2024

by: Roy Edroso

A new billing policy requires that modifier 33 (Preventive services) appear with the social determinants of health (SDOH) assessment add-on code G0136 on all such claims submitted with annual wellness visits (AWV). This will mean a big change in that modifier’s utilization, which has mainly been limited to four codes (and overwhelmingly used for just one).

Subsequent hospital codes top combo with split/shared modifier

05/13/2024

by: Richard Scott

A clarification to the rules for split or shared billing took effect Jan. 1, and a look back at the most-billed codes in claim year 2022 reveals the most frequent locations and types of encounters that groups should keep a close eye on.

Advance care denials dropped as utilization surpassed 2.4M claims

05/06/2024

by: Julia Kyles, CPC

Practices have learned to avoid coding mistakes that trigger denials of advance care planning (ACP) services (99497-99498). The time-based services were introduced in 2015 and Medicare covered the codes in 2016.

Virtual check-in, e-visit codes opened strong in 2020, then collapsed

04/29/2024

by: Roy Edroso

There was a burst of enthusiasm among providers when e-visits became billable to Medicare at the outset of the COVID-19 pandemic, but that excitement quickly waned and hasn’t bounced back.

X-tra special: 59-alternative X modifiers dial back the denials

04/22/2024

by: Richard Scott

When practices turn to a substitute for modifier 59 (Distinct procedural service), two options from the series of Medicare-approved X[EPSU] modifiers stand high above the rest, and in most cases the claims-approval rates are superior.

FFS Medicare fades, as Medicare Advantage surges in enrollment

04/15/2024

by: Roy Edroso

The most recent CMS numbers show Medicare Advantage enrollment continuing to outpace traditional Medicare, and some measures suggest Part C has already beat fee-for-service Medicare to become the majority Medicare insurer.

Active status for Category III codes doesn’t lead to active billing

04/08/2024

by: Julia Kyles, CPC

CMS lists most Category III — or temporary — codes as carrier-priced. That means that each Medicare administrative contractor (MAC) will decide whether it will pay for a service on a case-by-case basis. In recent years the agency has granted active status to a few temporary codes, but a look at early Medicare Part B claims data shows that active status doesn’t generate a lot of buzz.

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