Part B News | Benchmark of the Week

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

04/22/2024

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.

Lesion-destruction codes top list of 59-appended services; labs lose

04/01/2024

by: Richard Scott

For the second year running, providers turned to modifier 59 (Distinct procedural service) most often when performing a lesion-destruction service, and denials held steady for codes 17003 and 17000. But keep an eye on a duo of lab codes: the denial rates on 87798 and 87481 shot up significantly in 2022.

CCM and chronic CCM claims remain robust after pandemic

03/25/2024

by: Roy Edroso

Medicare’s chronic and complex chronic care management (CCM) codes continued their upward climb in 2022, and the power users among specialties remained mostly constant.

Backed by rate rise, telehealth remains popular with providers, patients

03/18/2024

by: Julia Kyles, CPC

Nearly half of eligible Medicare Part B patients received a routine office visit via telehealth in the early days of the COVID-19 public health emergency (PHE), and while the percentage decreased in ensuing years it still remained well above pre-PHE standards.

More claims go in for G0439, but payments take a nosedive

03/11/2024

by: Richard Scott

While practices continue to ramp up the number of annual wellness visits (AWV) they provide to patients, they witnessed a payment hole in 2022, in what appears to be a demographically driven discrepancy.

After code switch, psych and neuro tests perform well, with exceptions

03/04/2024

by: Roy Edroso

After a major coding changeover, psychological and neuropsychological testing claims have continued to rise in overall utilization. But watch a few related codes that have had a harder time of it.

POS changes reveal hospital outpatient E/M trends

02/26/2024

by: Julia Kyles, CPC

Hospitals report twice as many Part B E/M services in their on-campus outpatient departments compared to services in off-campus outpatient departments. However, overall E/M reporting in outpatient hospital settings didn’t drastically change after CMS instituted new place of service (POS) policies in 2016.

HHS audit uncovers raft of overpayments for E/M services

02/19/2024

by: Richard Scott

Shore up your documentation and strengthen your coding accuracy to ensure your claims aren’t falling into incorrect or fraudulent territory. The Comprehensive Error Rate Testing program under HHS found more than $3.7 billion in improper payments made to a series of E/M services, including more than $660 million in errors for a single E/M office visit code (99214).

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