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Benchmark of the Week
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.
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 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.
CMS’ proposal to let 19 preventive services codes be billed with prolonged service add-on codes is good news to many providers. But it’s only good if they can get those codes accepted in the first place — and some of them have given providers trouble.
Clinical social workers, psychologists and podiatrists are among 11 specialty groups slated to receive additional payments for their services in 2018, according to projected allowed charges contained in the proposed 2018 Medicare physician fee schedule.

Denial rates on key vaccine codes from 2013 to 2015, which are the most recent years for Medicare data, have been remarkably consistent and suggest that billing problems with some codes are due to long-known issues. The data also suggest many practices just haven’t caught on yet.

Practices trimmed their denial rates associated with a suite of six debridement codes that they billed more than 3 million times in 2015, which is the latest year of available Medicare claims data.

If past performance is anything to go on, the merit-based incentive payment system (MIPS) will see participation grow at a brisk clip over the next several years.

You can give yourself a pat on the back for your drug-code billing — many of the most-reported drug codes showed low denial rates over calendar years 2014 and 2015.
Maybe practice makes perfect. Some specialties that billed new patient office E/M codes more than a million times in 2015 actually did well with them, compared with the generally high overall denial rate for those codes.


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