Part B News | Benchmark of the Week

E/M fees, already buoyant in 2021, see added gains under revamped rates

01/18/2021

The outlook on E/M office visit payments was looking strong heading into 2021, but recent fee changes are on track to supercharge those services.

Amid stable modifier use, repeat procedure code 76 pops 37% in 2019

01/11/2021

by: Roy Edroso

The most-used modifiers list didn’t change much in 2019 compared to the previous year — except for one particular modifier used in multi-line billing.

Amid telehealth surge, experts wonder whether 2021 is the go-big year

01/04/2021

by: Richard Scott

While 2020 will always be remembered for the COVID-19 pandemic and the mass casualties and despair around the nation and the world, the lasting effects of the virus are also likely to reshape the delivery of health care in myriad ways. One of the lasting changes may be the vast expansion of telehealth services.

CMS selected-procedure chart highlights the 2021 CF blow to reimbursement

12/21/2020

by: Roy Edroso

Among the documents related to the final 2021 Medicare physician fee schedule that should interest practices is the “Impact on CY 2021 payment for selected procedures” chart, showing the estimated impact of reimbursement changes on procedures chosen by CMS “from among the procedures most commonly furnished by a broad spectrum of specialties.”

2021 Part B fee projections: Top specialties adding – and losing – revenue

12/14/2020

by: Richard Scott

It’s a topsy-turvy fee outlook in 2021, as medical practices are projected to see wild fluctuations in Part B charges in the new year. With specialty-specific gains reaching as high as 16% – and losses also reaching double digits – your billing patterns are likely to tell how your Medicare charges will fare.

Use of E/Ms with modifier 24 remains stable, but denial rates fall hard

12/07/2020

by: Roy Edroso

Considering its stringent requirements, you may expect claims with modifier 24 (Unrelated E/M service during a postoperative period) to see a lot of denials. But their rates are actually very low, especially compared to where they were four years earlier.

Providers again clear $1B in revenue for critical care services

11/23/2020

by: Richard Scott

The critical care code set may be small in size, consisting of two CPT codes (99291, 99292), but it packs a wallop when it comes to provider revenue. In 2019, practices surpassed the $1 billion mark in payments tied to the two codes.

2019 Medicare claims: More utilization and payments, lower denial rate

11/16/2020

by: Roy Edroso

CMS released its Part B claims numbers for 2019 on Nov. 5, and the yearly numbers show nearly everything growing except two areas: denial rates and E/M utilization.

Review advance care planning charts before OIG starts its audit

11/09/2020

by: Julia Kyles, CPC

Check the time and other possible billing hazards for advance care planning (ACP) claims. The two ACP codes (99497, 99498) show an average denial rate of 19% since Medicare started covering the service, which may be a sign that practices are making easy-to-avoid mistakes for the two codes.

Payments, claims flow forth for lucrative psychiatric diagnostic codes

11/02/2020

by: Richard Scott

Provider payments for two psychiatric diagnostic evaluation codes (90791, 90792) maintained steady growth in recent years, returning more than $140 million in fees in 2018, the latest year of available Medicare claims data.

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