Part B News | Benchmark of the Week

TCM claimants improve as utilization goes up, denials go down

04/23/2018

Claims for transitional care management (TCM) codes 99495-99496 are up and denials are down, but the rising tide is not lifting some specialties (like neurosurgery) nor some places of service (like inpatient hospitals).

Check opioid prescribing habits against average for your practice’s specialties

04/16/2018

by: Julia Kyles

Use the latest comparative billing report (CBR) to determine whether your practice’s clinicians may be flagged for a higher-than-average prescribing pattern.

Physical therapy claims rise, denials fall over recent three-year period

04/09/2018

by: Richard Scott

The most frequently reported physical therapy code, 97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility), topped $1.1 billion in payments in 2016, the latest year of available Medicare claims data.

AMA docs: Prior authorizations can be lengthy, often impact care

04/02/2018

by: Roy Edroso

An AMA survey of 1,000 practicing physicians finds that prior authorization for medical services isn’t just annoying for them — it’s possibly a net loss for their patients’ health.

Some providers continue to bill Medicare for non-covered consultation codes

03/26/2018

by: Richard Scott

Despite Medicare’s decision to no longer cover a suite of five outpatient consultation codes (99241-99245) nearly a decade ago, providers continue to pursue a mission impossible and seek payment for thousands of visits per year.

Growth, rewards in CPAP-related billing — but watch those denials

03/19/2018

by: Roy Edroso

Use of codes related to sleep apnea and continuous positive airway pressure (CPAP) continues to grow, but denial rates show providers have to be careful.

Psychologists, therapists report bulk of cognitive therapy claims amid code swap

03/12/2018

by: Richard Scott

Clinical psychologists outpaced other specialists when reporting cognitive-training code 97532, now deleted, yet all reporters, including occupational therapists and primary care providers, should take note of CMS’ guidance to use HCPCS code G0515 (Development of cognitive skills to improve attention, memory, problem solving [includes compensatory training], direct [one-on-one] patient contact, each 15 minutes) in its place in 2018.

Knee X-ray codes go down easy – except for some modifier combos

03/05/2018

by: Roy Edroso

The five CPT knee X-ray codes have relatively low denial rates – except for a bit of mayhem with the two least-used codes.

Knee X-ray codes go down easy — except for some modifier combos

03/05/2018

by: Roy Edroso

The five CPT knee X-ray codes have relatively low denial rates — except for a bit of mayhem with the two least-used codes.

Telehealth codes little used, but signs point to changes

02/26/2018

by: Roy Edroso

The difficulties attached to getting Medicare to pay for telehealth services — the originating-site and sometimes geographical restrictions — are evident in the low utilization for the codes specifically dedicated to telehealth. But some of the denial rates are low and, if hints from CMS mean what they seem, the codes may see more use in years to come.

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