Part B News | Benchmark of the Week

Lesion-removal, skin codes top list of most-used services facing unit cuts

12/17/2018

Among a raft of codes that are on track to lose eligible service amounts in the new year, you’ll find a series of lesion-removal services and other integumentary procedural codes, according to the Correct Coding Initiative (CCI) version 25.0 edits taking effect Jan. 1

Denials improve for claims with modifier 50

12/10/2018

by: Roy Edroso

In past five years, providers have vastly improved their denial rates on codes with modifier 50 (Bilateral procedure), Medicare data show.

Top 10 winners and losers of the 2019 Medicare fee schedule

12/03/2018

by: Richard Scott

Now that the scores are in, you can assess the winners and losers of the final 2019 Medicare physician fee schedule, which increased the payment rates of some oft-used codes and slashed rates on others.

MRI codes an easy pass — unless you miss policy changes

11/19/2018

by: Roy Edroso

Denial rates for codes related to magnetic resonance imaging (MRI) under Medicare are not terrible, but watch out for a few high-rejection codes and make sure you’re keeping up on CMS and contractor news and changes on the ones you use.

Winners and losers of E/M payment changes: An early look at pay-rate impacts

11/12/2018

by: Richard Scott

When it comes to E/M payments, you’ll enter a business-as-usual cycle on Jan. 1 after CMS opted to delay its proposed sweeping changes for two years. But with a vast array of revisions on the books for 2021, it’s not too early to glimpse the financial outcomes of the single-pay rates and other changes looming ahead.

4 of 5 enrollees in Medicare Advantage plans that require prior authorizations

11/05/2018

by: Richard Scott

The growing wave of Medicare Advantage (MA) plans may increase the administrative time your practice spends chasing down prior authorizations, as the bulk of MA patients – about 80% – are in a plan that requires one for at least some services, according to new analysis from Kaiser Family Foundation (KFF).

KFF: 99% of Medicare beneficiaries can get Medicare Advantage coverage

10/29/2018

by: Roy Edroso

The growth in Medicare Advantage plans is impressive, but the penetration of those plans into heretofore underserved areas may be even more so, on the evidence of the Kaiser Family Foundation’s recent issue brief “Medicare Advantage 2019 Spotlight: First Look” by Gretchen Jacobson, Anthony Damico and Tricia Neuman.

Payments for AWV code G0439 jump 152% over five-year period

10/22/2018

by: Richard Scott

Experts say it’s still a tricky and underutilized service, but the numbers behind the annual wellness visit (AWV) wouldn’t make you think so

Reporting requirements, scoring are most disliked parts of MIPS, survey says

10/15/2018

by: Richard Scott

As year two of the Quality Payment Program (QPP) winds down, practices report ongoing challenges with CMS’ full-bore pivot to value-based care and dissatisfaction with specific elements of the program, according to a survey from the Medical Group Management Association (MGMA) in Englewood, Colo.

Several specialties make a good show among most-used E/M codes

10/08/2018

by: Roy Edroso

The provider types that tend to make the most use of the 10 office E/M codes (99201-99215) are a mixed bag of specialists and primary care providers, but the big news in the most recent Medicare utilization numbers from 2017 is the continuing rise in use of the codes by nurse practitioners (NPs) and physician assistants (PAs).

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