Part B News | Benchmark of the Week

Impact of the projected conversion factor cut will vary across services

07/29/2024

Office or other outpatient E/M visits will be among the codes that fare the best under the projected conversion factor cut that CMS released with the proposed 2025 Medicare physician fee schedule. High-volume eye care codes will see the biggest drops next year.

Caregiver training featured among new HCPCS codes

07/22/2024

by: Richard Scott

CMS seeks to maintain a focus on behavioral health management, debuting a range of new HCPCS codes that, should they become finalized, would add a bevy of new billing opportunities for Part B providers come Jan. 1, 2025.

Denial rates edge up as claims fall for critical care codes

07/15/2024

by: Richard Scott

Despite a decrease in the number of claims for critical care services that medical groups billed to Medicare Part B, denial rates have inched up over a recent four-year stretch.

Weak pay raises for lower-level clinical staff, especially MAs, RNs

07/08/2024

by: Roy Edroso

A new Medical Group Management Association (MGMA) survey finds that while increased patient volume presents challenges for many practices, pay rates for medical assistants (MA) who can help ease that pressure have only risen slightly in the past year. Over the same period, other clinical and nursing staff did better.

Pinpoint high-rate denials for modifier 25; some E/Ms top the list

07/01/2024

by: Richard Scott

Watch out for turbulence when turning to modifier 25 (Significant, separately identifiable E/M service) for E/M services submitted on the same date as a procedure. Several of the most frequently reported E/M codes, including level one established visit code 99211, garnered double-digit denial rates.

Providers favored the on-campus setting for outpatient services in 2022

06/24/2024

by: Julia Kyles, CPC

Outpatient services performed on a hospital’s main campus dominated the incidence of total outpatient services in 2022, encompassing a far greater share of visits than their off-campus counterparts.

Survey shows Miss. tops for PCP, non-surgical specialist pay; D.C. lags

06/17/2024

by: Roy Edroso

The latest MGMA physician compensation report doesn’t just have financial figures for different practice types. It also looks at the top states and regions for compensation by different kinds of practitioner, some of which may be a surprise to you.

1 to 2 muscle trigger point injections fall 33% in 5 years

06/10/2024

by: Richard Scott

The rates of administering trigger point injections (TPI) have dropped dramatically in recent years, and providers have witnessed an associated revenue shortfall for the two primary TPI codes used for pain management.

QPP 2022: Clinicians at small practices preferred group reporting

06/03/2024

by: Julia Kyles, CPC

Nearly 60% of small practices used the group reporting option to participate in the 2022 Quality Payment Program (QPP), and nearly 45% of small practices that participated via group reporting received the small practice bonus, according to Part B News analysis of the 2022 QPP Public Use File (PUF), which contains the most recent data on QPP participation.

G0136 joins select group of codes cleared for use with modifier 33

05/20/2024

by: Roy Edroso

A new billing policy requires that modifier 33 (Preventive services) appear with the social determinants of health (SDOH) assessment add-on code G0136 on all such claims submitted with annual wellness visits (AWV). This will mean a big change in that modifier’s utilization, which has mainly been limited to four codes (and overwhelmingly used for just one).

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