Part B News | Benchmark of the Week

With one exception, selected codes take big hit in 2023

12/05/2022

When Part B News looked at the “Impact on CY 2022 payment for selected procedures” that came with the physician fee schedule last year, there was not a single rate gainer among the 23 codes with non-facility rates. Flash forward to that list for 2023, and you’ll find that – with one significant exception – the situation is even worse.

Denials for prolonged codes hint at trouble for practices in the new year

11/21/2022

by: Julia Kyles, CPC

Practices will experience a spike in denials for prolonged services in 2023 if they aren’t prepared for the next round of coding updates. Medicare Part B claims data show that denials for prolonged services by physicians and qualified health care professionals (QHP) in the outpatient setting (99354 and 99355) increased from an average of 10% in 2020 to an average of 30% in 2021.

Most specialties projected to lose charges in 2023: Fee schedule

11/14/2022

by: Richard Scott

The number of specialties welcoming a boost to their allowed charges in 2023 is far outpaced by those facing projected cuts, according to relative value unit (RVU) revisions announced in the final 2023 Medicare physician fee schedule released Nov. 1.

Part B claims in 2021 inched up, but payment surged

11/07/2022

by: Roy Edroso

After stalled growth in 2020, practices lived through a modest recovery in utilization in 2021. For payments, however, it was a banner year.

After emergency medicine, PCPs and surgeons take over ER

10/31/2022

by: Julia Kyles, CPC

Thanks to popular media, the public may think that physicians and nurses who specialize in emergency medicine are the only providers who work in the emergency department. But the latest Medicare Part B data for emergency department E/M visits (99281-99285) reveals that members of any specialty can and do provide emergency department services.

Heaps of ‘after-hours’ codes reported, and all denied

10/24/2022

by: Richard Scott

Despite a non-payable status under Medicare, a series of six codes that reflect care provided during irregular or emergency hours garnered hundreds of thousands of claims – and returned zero dollars – in 2021.

Gastro codes do well with modifier 53, but 52 has some denial traps

10/10/2022

by: Roy Edroso

The modifiers 52 (Reduced services) and 53 (Discontinued procedure) often confuse providers. While total utilization remains low – 184,489 claims with 52 in 2021 and 30,850 for 53 the same year – your personal patterns may warrant another look, particularly if your practice performs a lot of the tests and exams that make up the bulk of services tied to these claims.

One obstacle for more advanced med tech adoption: Malpractice

10/03/2022

by: Roy Edroso

One critical factor in physicians’ decisions to use new medical technology is a concern that the new tech may expose the physician or practice to liability claims.

5 specialties led the charge for adopting remote physiologic monitoring

09/26/2022

by: Julia Kyles, CPC

Five specialties added new E/M remote physiologic monitoring (RPM) services to their practices in 2019 and continued to increase reporting in 2020. Internal medicine was at the head of the pack in 2019 and stayed there in 2020, according to a review of Medicare Part B data for 2019 and 2020, the latest available.

Providers amped up 60-minute psychotherapy service in 2020

09/19/2022

by: Richard Scott

Many psychotherapy services dipped in 2020; however, the 60-minute therapy service code gained claims while Part B payments grew by $28 million. And aside from psychiatric specialists, nurse practitioners were most likely to report a psychiatric diagnostic evaluation when also performing a separate E/M service.

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