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Benchmark of the Week
While mental health surfaced as a big topic during the COVID-19 crisis, most psychiatric evaluation and psychotherapy services didn’t see a major boost in claims. Nearly all saw a dip in utilization between 2019 and 2021, although the lone outlier grew enough, abetted by rate increases, that payments jumped more than $66 million.
Outside attempts to steal protected health information (PHI), such as ransomware attacks, dominate the headlines, but internal mistakes continue to trigger breaches involving at least 500 patients. Any provider who experiences a breach of that size must file a report with HHS that will be posted on the so-called HIPAA “wall of shame,” notify the affected patients, make a public announcement, take steps to mitigate harm to the patients and, often, weather the bad press that follows.
In a head-to-head showdown, the series of X modifiers that CMS permits for two or more procedures on the same date of service turned in favorable performances compared to modifier 59 (Distinct procedural service), even as total X-modifier claims came in low.
Primary care providers dominated the top five slots in total reporting of traditional chronic care management (CCM) involving at least two chronic conditions. However, a wide range of specialties rose to the top when CMS introduced two codes for the management of one complex chronic condition, also known as principal care management (PCM).
Amid reports of a potential retirement crisis among medical groups, administrators are underestimating the reason that many physicians are heading for the exits. Physicians indicate that burnout and financial concerns are two of the leading reasons to hang it up, yet few administrators see it that way.
Denials spiked for a variety of services performed in the hospital outpatient setting even as utilization tumbled, and a Medicare prior authorization policy may be one reason behind the change.
The lowered co-insurance rates on some average sales price (ASP) drugs in the 2nd quarter of 2023 is good news for some Part B drug users. But these modest cuts still represent only a small percentage of Medicare’s enormous drug tab.
Medical groups posted some big numbers in their use of modifier 25 (Significant, separately identifiable E/M service), reporting over 65 million claims and clearing $5 billion in payments in 2021, the latest year of available data. While payments grew, the usage numbers remained down from pre-COVID highs just two years earlier.
Claims for psychological, neuropsychological and neurobehavioral status testing increased and denials fell after the AMA made major revisions to the code sets in 2019, according to analysis of Medicare Part B data.
Trends in annual wellness visits (AWV), billed to Medicare as G0438 and G0439, and the initial preventive physical examination (IPPE), aka Welcome to Medicare visit (G0402), show that while the codes did not prosper in the first year of the COVID crisis in 2020, G0439 pulled out of its tailspin in 2021; the others, however, continued to underperform.


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