Part B News | Benchmark of the Week

Proposed cuts hit 38 of 40 high-utilization procedures, visits in CY2022

08/02/2021

Last year saw plenty of double-digit cuts in the “selected procedures” that CMS traditionally calls out to show the impact of the proposed physician fee schedule (PFS) on a suite of Medicare’s most frequently used codes.

2022 fee tally: Winners and losers under the proposed physician fee schedule

07/26/2021

by: Richard Scott

As providers brace for a nearly 4% cut to the 2022 conversion factor, the impact of relative value unit (RVU) changes on specialties fluctuates from a 10% gain for portable X-ray suppliers to a -9% drop for interventional radiology.

Numbers show public concern with surprise billing made new regs inevitable

07/19/2021

by: Roy Edroso

The new and upcoming rules related to surprise billing promise big changes for the health care industry, but as you can see from a series of figures from the Kaiser Family Foundation first published on Feb. 11, 2020, the issue had penetrated the consciousness of a large number of Americans and become a political issue that could hardly be ignored.

Medicare Advantage takes another bite out of traditional FFS enrollment

07/12/2021

by: Richard Scott

Medicare Advantage enrollment galloped forward at a 10% rate between 2020 and 2021, as the private plan alternative to original Medicare now has lassoed more than four in 10 (42%) beneficiaries.

Preventive services codes keep going up – and some pay big

07/05/2021

by: Roy Edroso

The series of preventive services codes that practices turned to most frequently did not change much between 2018 and 2019, except that their utilization continues to climb.

BHI class of 2018 codes show growth, but with denial teething pains

06/21/2021

by: Roy Edroso

CMS has been pushing for wider use of its behavioral health codes, which you can see in the big push to get providers to use 99483 (Assessment of and care planning for a patient with cognitive impairment). The uptake has been on the slow side, but signals are flashing that the pace may pick up over time.

High modifier 25-based revenue could attract auditor interest

06/14/2021

by: Julia Kyles, additional reporting by Richard Scott

Watch a recent addition to the HHS Office of Inspector General’s (OIG) Work Plan: It may have implications for practices that frequently report a procedure and an E/M visit during the same patient encounter.

Top codes with POS 11 intersect little with most-reported claims

06/07/2021

by: Roy Edroso

You might expect that the most-used codes billed under place of service (POS) 11 (Office) would closely mirror the most-reported codes overall. But aside from the two most popular E/M codes, they don’t much overlap.

Testing codes, marked by modifier 26, bring in scores of cash for practices

05/24/2021

by: Richard Scott

Medical practices returned reams of money on leading services that they reported with modifier 26 (Professional component), including a spate of X-ray codes, tissue exams and other testing codes.

Hospital claims shift reveals a dip in inpatient codes, and a bigger one in denials

05/17/2021

by: Roy Edroso

In a recent five-year span, the use of inpatient codes declined at a faster rate than they had in previous years, and denial rates dropped even more quickly.

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