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Benchmark of the Week
Last year saw plenty of double-digit cuts in the “selected procedures” that CMS traditionally calls out to show the impact of the proposed physician fee schedule (PFS) on a suite of Medicare’s most frequently used codes.
As providers brace for a nearly 4% cut to the 2022 conversion factor, the impact of relative value unit (RVU) changes on specialties fluctuates from a 10% gain for portable X-ray suppliers to a -9% drop for interventional radiology.
The new and upcoming rules related to surprise billing promise big changes for the health care industry, but as you can see from a series of figures from the Kaiser Family Foundation first published on Feb. 11, 2020, the issue had penetrated the consciousness of a large number of Americans and become a political issue that could hardly be ignored.
Medicare Advantage enrollment galloped forward at a 10% rate between 2020 and 2021, as the private plan alternative to original Medicare now has lassoed more than four in 10 (42%) beneficiaries.
The series of preventive services codes that practices turned to most frequently did not change much between 2018 and 2019, except that their utilization continues to climb.
by: Roy Edroso
CMS has been pushing for wider use of its behavioral health codes, which you can see in the big push to get providers to use 99483 (Assessment of and care planning for a patient with cognitive impairment). The uptake has been on the slow side, but signals are flashing that the pace may pick up over time.
Watch a recent addition to the HHS Office of Inspector General’s (OIG) Work Plan: It may have implications for practices that frequently report a procedure and an E/M visit during the same patient encounter.
You might expect that the most-used codes billed under place of service (POS) 11 (Office) would closely mirror the most-reported codes overall. But aside from the two most popular E/M codes, they don’t much overlap.
Medical practices returned reams of money on leading services that they reported with modifier 26 (Professional component), including a spate of X-ray codes, tissue exams and other testing codes.
In a recent five-year span, the use of inpatient codes declined at a faster rate than they had in previous years, and denial rates dropped even more quickly.


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