Part B News | Benchmark of the Week

Check the discharge: TCM claims should be backed by the inpatient discharge record

06/25/2018

Practices that perform transitional care management (TCM) services (99495-99496) should work with inpatient facilities to confirm the date a patient was discharged. The documentation for TCM services should include the date the patient was discharged from an inpatient facility, such as a hospital or skilled nursing facility. However, a comparative billing report performed last year found that some TCM claims did not have a matching discharge record from the facility.

Obesity-counseling claims keep rising but high denial rates stick

06/18/2018

by: Richard Scott

Practices around the country are providing a greater number of obesity-counseling services, as the 307,000 claims of G0447 (Face-to-face behavioral counseling for obesity, 15 minutes) in 2016 indicate.

AWV, IPPE denials stay high; initial AWV use, after a burst, falls

06/11/2018

by: Roy Edroso

Providers have seen no big break in the long tradition of high denials for both initial (G0438) and subsequent (G0439) annual wellness visits (AWVs), nor for the Welcome to Medicare visit (G0402; also known at the Initial Preventive Physical Examination or IPPE).

Per-capita E/M costs are $465 in Minot, N.D., but nearly $1,600 in Fort Lauderdale

06/04/2018

by: Richard Scott

Your location may determine how much money you earn through routine E/M encounters and, more generally, how patients receive their health care services, according to a Part B News analysis of recently released Medicare claims data.

Foot orthotics hard to bill — unless they meet strict standards

05/21/2018

by: Roy Edroso

The difficulty of getting paid by Medicare for foot orthotics is obvious when you look at the denial rates on related codes. This is obvious from the chart below of codes for foot inserts — including L3000 (Foot, insert, removable, molded to patient model, ‘ucb’ type, berkeley shell, each), with which a reader was having trouble in this issue’s Ask Part B News story (see p. 4).

Millions gained from ESRD management codes as billing restrictions loosen

05/14/2018

by: Richard Scott

Despite warning, cataract claims steady since 2014 — but not with modifier 55

05/07/2018

by: Roy Edroso

Watch out for cataract surgery and other ophthalmological claims with modifier 55 (Postoperative management only). The modifier draws special contractor scrutiny for the post-op provider.

Telehealth-based E/M encounters, psychotherapy services gain dollars

04/30/2018

by: Richard Scott

Providers are increasingly tapping into telehealth to conduct patient encounters, using the video-based technology to perform E/M services and psychiatric visits, according to a review of the latest Medicare claims data.

TCM claimants improve as utilization goes up, denials go down

04/23/2018

by: Roy Edroso

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.

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