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Benchmark of the Week
04/15/2024
The most recent CMS numbers show Medicare Advantage enrollment continuing to outpace traditional Medicare, and some measures suggest Part C has already beat fee-for-service Medicare to become the majority Medicare insurer.
04/08/2024
CMS lists most Category III — or temporary — codes as carrier-priced. That means that each Medicare administrative contractor (MAC) will decide whether it will pay for a service on a case-by-case basis. In recent years the agency has granted active status to a few temporary codes, but a look at early Medicare Part B claims data shows that active status doesn’t generate a lot of buzz.
04/01/2024
For the second year running, providers turned to modifier 59 (Distinct procedural service) most often when performing a lesion-destruction service, and denials held steady for codes 17003 and 17000. But keep an eye on a duo of lab codes: the denial rates on 87798 and 87481 shot up significantly in 2022.
03/25/2024
Medicare’s chronic and complex chronic care management (CCM) codes continued their upward climb in 2022, and the power users among specialties remained mostly constant.
03/18/2024
Nearly half of eligible Medicare Part B patients received a routine office visit via telehealth in the early days of the COVID-19 public health emergency (PHE), and while the percentage decreased in ensuing years it still remained well above pre-PHE standards.
03/11/2024
While practices continue to ramp up the number of annual wellness visits (AWV) they provide to patients, they witnessed a payment hole in 2022, in what appears to be a demographically driven discrepancy.
03/04/2024
After a major coding changeover, psychological and neuropsychological testing claims have continued to rise in overall utilization. But watch a few related codes that have had a harder time of it.
02/26/2024
Hospitals report twice as many Part B E/M services in their on-campus outpatient departments compared to services in off-campus outpatient departments. However, overall E/M reporting in outpatient hospital settings didn’t drastically change after CMS instituted new place of service (POS) policies in 2016.
02/19/2024
Shore up your documentation and strengthen your coding accuracy to ensure your claims aren’t falling into incorrect or fraudulent territory. The Comprehensive Error Rate Testing program under HHS found more than $3.7 billion in improper payments made to a series of E/M services, including more than $660 million in errors for a single E/M office visit code (99214).
02/12/2024
The most-used Medicare screening services took a tumble in 2020, the first year of the COVID-19 public health emergency, and seemed to be staging a comeback in 2021. The most recent available figures, however, suggest any comeback is leveling off.

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