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Benchmark of the Week

Most practices will take a cut of 1% to Medicare payments in 2018 or see a neutral adjustment as a result of their performance during the final reporting year of the value modifier program, which CMS phased out at the end of 2016.

When you’re forced to end a procedure early or, alternately, report additional work because of unexpected factors, two little used modifiers – CPT modifiers 53 (Discontinued procedure) and 22 (Increased procedural service) – offer a means to accurately report your efforts.

Don’t count on three modifiers to automatically redeem otherwise duplicate claims: The most recent data show the overall denial rate on codes claimed with the modifiers went into double digits, with some individual codes performing especially badly.

The steady increase of 99214 encounters, which topped 103.6 million visits in 2016, was largely the product of non-physician practitioners (NPPs) and other specialty groups — including hematologists/oncologists, neurologists and urologists — filing more claims, according to a review of historical Medicare claims data.
The good news for practices whose providers tend to use modifier 24 (Unrelated E/M, same physician, post-operative) is that the denial rates of the codes most often used with that modifier went down in 2016, the most recent year of available Medicare data.
Physician practices received significant payments — more than $4 billion — on 10 frequently reported E/M services performed the same day as a minor procedure or other service, according to a review of 2016 Medicare claims data, the most recent available.
Top specialties saw office E/M utilization go down between 2014 and 2016, the most recent year for which we have Medicare data — except for the two top-billing categories of non-physician practitioners (NPP).
CMS will allow merit-based incentive payment system (MIPS) participants to turn in a minimum amount of data to avoid penalties, but Part B News’ 2018 Predictions Survey shows practices are far more likely to go for a positive payment adjustment. And a surprising number appear to be involved in value-based care models.

Providers billing immunosuppressive drug claims saw some — but not much — resistance to the several hundred millions of claims they submitted in 2015 and 2016, according to an analysis of Medicare claims data from the two most recently available periods.

Give yourself a pat on the back for work well done. By and large, practices that reported multiple procedures on the same date of service performed admirably in 2016, according to a Part B News analysis of recently available Medicare claims data.


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