Part B News | Benchmark of the Week

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.

Modifier 59 claims return nearly $1.5 billion in Medicare payments

05/10/2021

by: Richard Scott

Mastering the use of modifiers can be lucrative business for physician practices, as the latest modifier 59 (Distinct procedural service) utilization numbers reveal. In 2019, providers pulled in nearly $1.5 billion from Medicare on thousands of codes paired with the modifier.

Diabetes training, education codes up slightly, but no relief from denials

05/03/2021

by: Roy Edroso

Though CMS estimates that one in five Americans aged 65 years and over has either type 1 or type 2 diabetes, Medicare’s codes for services that help diabetic patients cope with their disease have not performed very strongly in recent years, and are beset with high denial rates.

Nursing facility payments show strong growth, as NPs boost their claims

04/26/2021

by: Richard Scott

Providers pulled in nearly $1.5 billion in payments for subsequent nursing facility encounters in 2019, continuing a strong rate of growth largely fueled by an uptick in nurse practitioner visits.

TCM continues climb, but some specialties, sites of service stumble

04/19/2021

by: Roy Edroso

While it’s not used as often as other care management services in Medicare Part B, transitional care management (TCM) has witnessed steady growth overall, and its denial rates remain low. But there are some provider types claiming from some facility types that don’t do so well with them.

Interprofessional consults slow to lift, but fees can pad your revenue

04/12/2021

by: Richard Scott

Medical practices showed a tepid response to the launch of a series of interprofessional consultations in 2019, the first year that CMS approved the codes for reimbursement.

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