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Benchmark of the Week
02/19/2018

Most practices will take a cut of 1% to Medicare payments in 2018 or see a neutral adjustment as a result of their performance during the final reporting year of the value modifier program, which CMS phased out at the end of 2016.

02/12/2018
When you’re forced to end a procedure early or, alternately, report additional work because of unexpected factors, two little used modifiers – CPT modifiers 53 (Discontinued procedure) and 22 (Increased procedural service) – offer a means to accurately report your efforts.
02/05/2018

Don’t count on three modifiers to automatically redeem otherwise duplicate claims: The most recent data show the overall denial rate on codes claimed with the modifiers went into double digits, with some individual codes performing especially badly.

01/29/2018
The steady increase of 99214 encounters, which topped 103.6 million visits in 2016, was largely the product of non-physician practitioners (NPPs) and other specialty groups — including hematologists/oncologists, neurologists and urologists — filing more claims, according to a review of historical Medicare claims data.
01/22/2018
The good news for practices whose providers tend to use modifier 24 (Unrelated E/M, same physician, post-operative) is that the denial rates of the codes most often used with that modifier went down in 2016, the most recent year of available Medicare data.
01/15/2018
Physician practices received significant payments — more than $4 billion — on 10 frequently reported E/M services performed the same day as a minor procedure or other service, according to a review of 2016 Medicare claims data, the most recent available.
01/08/2018
Top specialties saw office E/M utilization go down between 2014 and 2016, the most recent year for which we have Medicare data — except for the two top-billing categories of non-physician practitioners (NPP).
01/01/2018
CMS will allow merit-based incentive payment system (MIPS) participants to turn in a minimum amount of data to avoid penalties, but Part B News’ 2018 Predictions Survey shows practices are far more likely to go for a positive payment adjustment. And a surprising number appear to be involved in value-based care models.
12/18/2017

Providers billing immunosuppressive drug claims saw some — but not much — resistance to the several hundred millions of claims they submitted in 2015 and 2016, according to an analysis of Medicare claims data from the two most recently available periods.

12/11/2017
Give yourself a pat on the back for work well done. By and large, practices that reported multiple procedures on the same date of service performed admirably in 2016, according to a Part B News analysis of recently available Medicare claims data.

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