Part B News | Benchmark of the Week

Watch for replacements for 94620 and 97532 or risk denied claims

10/16/2017

Of the 82 CPT codes that are to be cleared out as part of the latest CPT changes, two popular codes slated for deletion may especially have an effect on your revenue if you’re not paying attention.

Prepare for new codes as imaging of chest, abdomen gets updated

10/09/2017

by: Richard Scott

Get ready to pivot to a new suite of imaging codes in 2018 to avoid revenue disruptions that may occur as a slate of current X-ray codes go on the chopping block.

Hospital E/M use, denials holding steady; NPPs a hidden success story

10/02/2017

by: Roy Edroso

Take note of some interesting patterns among specialties when it comes to hospital inpatient codes, even if the codes’ utilization and denial rates haven’t changed much in recent years.

Specialists seize a chunk of the $31 million in CCM payments

09/25/2017

by: Richard Scott

Many specialty groups beyond primary care took in significant chronic care management (CCM) payments in 2015, with the $31.3 million in reimbursement spread across dozens of specialties.

Some soon-to-be-bundled eye exam codes easily accepted — a few, much less so

09/18/2017

by: Roy Edroso

Of the six eye exam codes eye that will be bundled in new CCI code pairs, four had relatively stable denial rates between 2011 and 2015 — but two of them had remarkably high and much less stable denial rates.

Some specialists should watch out for coming apheresis policy change

09/11/2017

by: Richard Scott

Some specialty providers, including those in pathology, nephrology and orthopedic surgery, may have a difficult time seizing payments for apheresis services following a supervision change in one Medicare administrative contractor’s (MAC’s) jurisdiction.

Professional services modifier 26 goes down smooth — but watch for outliers

08/28/2017

by: Roy Edroso & Julia Kyles

With a few exceptions, Medicare providers seem to have a pretty good understanding of modifier 26 (Professional services) and see denial rates mostly lower than 10%, though some notable exceptions exist.

Cardio, pulmonary docs among specialists who frequently report flu vaccines

08/21/2017

by: Richard Scott

As a new flu vaccine debuts in 2017, the vaccine’s billing rules hold cross-specialty appeal because primary care providers are not the only ones to report flu claims.

Don’t use the wrong therapy modifier — especially if you’re a therapist

08/14/2017

by: Roy Edroso

The use of therapy modifiers — GO (Services delivered under an outpatient speech language pathology plan of care); GN (Services delivered under an outpatient occupational therapy plan of care); or GP (Services delivered under an outpatient physical therapy plan of care) — changes the billing results on always- and sometimes-therapy codes, especially if you’re a therapy provider using the wrong one.

Payments reach billions for medically necessary modifier-25 services

08/07/2017

by: Richard Scott

Payments for E/M services appended with modifier 25 (Significant, separately identifiable E/M service) topped $2.5 billion in 2015, according to the latest available Medicare claims data.

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