Part B News | Benchmark of the Week

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

10/15/2018

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).

Large pay gains tied to greater advance care planning activity in 2017

10/01/2018

by: Richard Scott

Claims for advance care planning codes 99497-99498 increased significantly between 2016 and 2017, topping out at nearly 1.3 million services collectively, according to the most recent Medicare claims data.

Unlisted codes a poor bet for success, especially if you miss a memo

09/24/2018

by: Roy Edroso

Providers don’t like to use unlisted codes if they can help it, and no wonder — the denial rates are ridiculous.

Prolonged codes for clinical staff go largely unused, face high denials

09/17/2018

by: Richard Scott

Most practices have been hesitant to tap into the prolonged service codes that are allowed when clinical staff spend extra time with a patient. Even as service utilization increased about 97% between 2016 and 2017, total claims remain scarce.

Proposed 50% markdown on E/M+25 scenarios means losses for common combos

09/10/2018

by: Roy Edroso

CMS’ plan in the proposed 2019 Medicare physician fee schedule to cut either a E/M charge or a procedure charge when modifier 25 is used would, if finalized, require some billing changes – and result in varying degrees of loss -- in common scenarios.

Double-check critical care services reported with modifier 25

08/27/2018

by: Julia Kyles, CPC

Practices that bill for critical care services (99291-99292) should make sure everyone understands the coding rules for these high-value codes, as well as the use of modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) with critical care services. The combination of critical care and modifier 25 is on auditor radar and could trigger denials.

Foreign body codes usually get over, but watch for problems – and play the odds on 65210

08/13/2018

by: Roy Edroso

There are 115 CPT codes accepted by Medicare that relate to the removal of a foreign body, and in 2016, the most recent year for which we have Medicare data, they were used only 491,376 times, with 18 codes being used fewer than 100 times, and 62163 (Neuroendoscopy, intracranial; with retrieval of foreign body) used zero times.

Add-on E/M codes produce payment gains under CMS proposals

08/13/2018

by: Richard Scott

As CMS considers significant E/M pay revisions, your reimbursement may vary based on the exact proposals the agency winds up adopting. The chart below compares the pay-rate differences between the current E/M rates and the single-stream rates for codes 99212-99215. The chart also details the positive impact of the proposed add-on codes that would apply to a dozen specialists.

Oft-reported venipuncture code shows scant denial rates among most specialists

08/06/2018

by: Richard Scott

Many specialists who often report blood-draw code 36415 (Collection of venous blood by venipuncture) outperform their peers in a comparison of national denial rates, according to Medicare claims data from 2016, the latest year available.

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