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Benchmark of the Week
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.
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).
The most-used Medicare screening services took a tumble in 2020, the first year of the COVID-19 public health emergency, and seemed to be staging a comeback in 2021. The most recent available figures, however, suggest any comeback is leveling off.
Providers were less likely to report an E/M modifier with an office/other outpatient visit one year after the new rules for reporting the visits went into effect.
After CMS finalized a regulatory path for easing the burden of prior authorizations, the agency offers some bullish projections on financial savings: Under the rule, individual and group physician practices would save $1.2 billion in the first year of implementation and more than $16 billion over 10 years.
Regular comprehensive exams are among the few services for which all Medicare beneficiaries are eligible. While initial preventive physical examinations (IPPE) and initial annual wellness visits (AWV) remain mired in their pandemic-era utilization numbers, subsequent AWVs continue a strong recovery.
The 2022 CPT Manual included 249 new codes across a range of services. However, analysis of the most recent Medicare Part B data reveals that the top 10 new procedure and service codes in 2022 were represented by additions to the manual’s E/M, anesthesia, eye and ocular adnexa, nervous system and medicine chapters.
Physicians who routinely set up a cardiac rhythm monitoring system for remote evaluations will be pleased with a financial boon for their effort in 2024. The payments for two specific cardiac rhythm monitoring codes, 93297 and 93298, are on track to rise 130% and 283%, respectively.
The new year is delivering a batch of fresh billing opportunities for medical groups, and many practices say they will take advantage of an E/M add-on code and an assessment service capturing patients’ social determinants of health.
Most of the interprofessional consultation services that saw a spike in claims during the initial COVID wave returned to lower utilization, except for a glaring outlier: the most-reported interprofessional consult code 99451 continues its surging growth trajectory.


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