Part B News | Benchmark of the Week

Final version of selected-procedure chart adds more pain

11/22/2021

The numbers contained in CMS’ short list of high-volume codes are even less rosy than this year’s earlier proposal, with harsher payment cuts coming in CY 2022.

CY2022 specialty impact: Final fee schedule winners and losers

11/15/2021

by: Richard Scott

While the 4% cut to the 2022 conversion factor is coming for all specialties, the impact of relative value unit (RVU) changes harbors its own outlook – fluctuating from a 6% gain for diagnostic testing facility to a -5% drop for interventional radiology and vascular surgery.

Monitor revised CPT codes that take changing descriptors in 2022

11/08/2021

by: Richard Scott

Get ready to sharpen your claims billing when the calendar flips to 2022 by adapting to a slate of CPT code revisions. Of the hundreds of CPT code changes taking effect Jan. 1, you’ll find 93 revised codes, many of which are impacting oft-reported services.

OIG review sets guideposts, possibly, for the future of telehealth

11/01/2021

by: Richard Scott

Most virtual encounters during the COVID-induced telehealth spike involved patients who had an established relationship with a provider, and that detail may influence federal policymaking on the future coverage of tech-enabled visits, according to an OIG analysis released Oct. 20.

First-level appeals drop, but success rate rises for Part B providers, DME

10/25/2021

by: Roy Edroso

If you’ve been doing better on Medicare appeals lately, you’re part of a trend. Between 2013 and 2020, the overall rate of success for providers and suppliers on redeterminations, the first level of formal Medicare appeals on claims denials, rose from 46.5% to 55% at Part B Medicare administrative contractors (MACs). And Part B durable medical equipment (DME) claimants did even better.

Prepare to sweep to-be-deleted codes from your claims billing

10/18/2021

by: Richard Scott

With the annual CPT code release now out, you’ll find hundreds of new, revised and deleted codes coming your way (see related story, p. 1). With numerous codes expiring, prepare to shift to alternative options for dozens of services and procedures in 2022.

Providers are using modifier 78 less, and getting fewer denials

10/11/2021

by: Roy Edroso

It looks as if providers have cut way back on their use of modifier 78 (Unplanned return to the operating room by the same physician fol-lowing initial procedure for a related procedure during the postoperative period). In 2019, the modifier appeared on a mere 94,255 claims, a major drop from 2015, when it was claimed more than 531,000 times.

OIG cautions against diagnosis coding fueled by chart reviews, HRAs

10/04/2021

by: Richard Scott

The manipulation of chart reviews and the vendor-led increase of in-home health risk assessments (HRA) may be inflating diagnosis coding levels, and be warned: The OIG and other federal groups are closely monitoring the activity.

Medicare FFS enrollment sputters as Medicare Advantage moves in

09/27/2021

by: Roy Edroso

The latest Medicare enrollment numbers show that while Medicare Advantage continues to gain a share of covered patients, traditional Medicare is fading fast.

Use 2020 telehealth report as a baseline for internal review

09/20/2021

by: Julia Kyles, CPC

The number of office E/M visits performed via telehealth spiked in April 2020, a sign that medical practices around the country took advantage of the relaxed rules for telehealth services that went into effect March 1, 2020.

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