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Benchmark of the Week
CMS seeks to maintain a focus on behavioral health management, debuting a range of new HCPCS codes that, should they become finalized, would add a bevy of new billing opportunities for Part B providers come Jan. 1, 2025.
Despite a decrease in the number of claims for critical care services that medical groups billed to Medicare Part B, denial rates have inched up over a recent four-year stretch.
A new Medical Group Management Association (MGMA) survey finds that while increased patient volume presents challenges for many practices, pay rates for medical assistants (MA) who can help ease that pressure have only risen slightly in the past year. Over the same period, other clinical and nursing staff did better.
Watch out for turbulence when turning to modifier 25 (Significant, separately identifiable E/M service) for E/M services submitted on the same date as a procedure. Several of the most frequently reported E/M codes, including level one established visit code 99211, garnered double-digit denial rates.
Outpatient services performed on a hospital’s main campus dominated the incidence of total outpatient services in 2022, encompassing a far greater share of visits than their off-campus counterparts.
The latest MGMA physician compensation report doesn’t just have financial figures for different practice types. It also looks at the top states and regions for compensation by different kinds of practitioner, some of which may be a surprise to you.
The rates of administering trigger point injections (TPI) have dropped dramatically in recent years, and providers have witnessed an associated revenue shortfall for the two primary TPI codes used for pain management.
Nearly 60% of small practices used the group reporting option to participate in the 2022 Quality Payment Program (QPP), and nearly 45% of small practices that participated via group reporting received the small practice bonus, according to Part B News analysis of the 2022 QPP Public Use File (PUF), which contains the most recent data on QPP participation.
A new billing policy requires that modifier 33 (Preventive services) appear with the social determinants of health (SDOH) assessment add-on code G0136 on all such claims submitted with annual wellness visits (AWV). This will mean a big change in that modifier’s utilization, which has mainly been limited to four codes (and overwhelmingly used for just one).
A clarification to the rules for split or shared billing took effect Jan. 1, and a look back at the most-billed codes in claim year 2022 reveals the most frequent locations and types of encounters that groups should keep a close eye on.


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