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Benchmark of the Week
Practices that perform transitional care management (TCM) services (99495-99496) should work with inpatient facili­ties to confirm the date a patient was discharged. The documentation for TCM services should include the date the patient was discharged from an inpatient facility, such as a hospital or skilled nursing facility. However, a comparative billing report performed last year found that some TCM claims did not have a matching discharge record from the facility.
Practices around the country are providing a greater number of obesity-counseling services, as the 307,000 claims of G0447 (Face-to-face behavioral counseling for obesity, 15 minutes) in 2016 indicate.

Providers have seen no big break in the long tradition of high denials for both initial (G0438) and subsequent (G0439) annual wellness visits (AWVs), nor for the Welcome to Medicare visit (G0402; also known at the Initial Preventive Physical Examination or IPPE).

Your location may determine how much money you earn through routine E/M encounters and, more generally, how patients receive their health care services, according to a Part B News analysis of recently released Medicare claims data.

The difficulty of getting paid by Medicare for foot orthotics is obvious when you look at the denial rates on related codes. This is obvious from the chart below of codes for foot inserts — including L3000 (Foot, insert, removable, molded to patient model, ‘ucb’ type, berkeley shell, each), with which a reader was having trouble in this issue’s Ask Part B News story (see p. 4).

Watch out for cataract surgery and other ophthalmological claims with modifier 55 (Postoperative management only). The modifier draws special contractor scrutiny for the post-op provider.

Providers are increasingly tapping into telehealth to conduct patient encounters, using the video-based technology to perform E/M services and psychiatric visits, according to a review of the latest Medicare claims data.

Claims for transitional care management (TCM) codes 99495-99496 are up and denials are down, but the rising tide is not lifting some specialties (like neurosurgery) nor some places of service (like inpatient hospitals).

Use the latest comparative billing report (CBR) to determine whether your practice’s clinicians may be flagged for a higher-than-average prescribing pattern.


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