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Benchmark of the Week
Despite their addition to the audio-only services list during the COVID-19 public health emergency (PHE), a series of psychiatric evaluation codes took a significant dip in 2020 when the pandemic suppressed claims across the board.
The 2020 proliferation in communications-based services extended beyond patient encounters, as physicians increasingly consulted with one another via phone, internet or other electronic channels.
Like many other services, hospital inpatient and observation numbers took a hit in the first pandemic year of 2020. But providers performed better in getting their claims accepted than before.
The growth of two services that Medicare has approved in recent years — cognitive assessment service 99483 and behavioral health care management code 99484 — signals that practices are spending more time addressing their patients’ behavioral health needs.
Providers issued fewer advance beneficiary notices of non-coverage (ABN) during the first year of the COVID-19 public health emergency (PHE) than they had in previous years, even as two ABN modifiers grew in popularity.
While use of modifier 59 (Distinct procedural service) dropped during the first COVID year of 2020, practices reported the four X modifiers that can be used in place of 59 at a similar clip as in 2019, and denials stayed comparatively lower.
More groups opted into the Medicare Shared Savings Program (MSSP) in 2022 than they did the previous year, ending a one-year slide that had softened enrollment rates in the national value-based model.
Behavioral health codes cleared for phone use in 2020 did not gain much in utilization compared to previous years, but providers were largely successful when reporting them.
The audio-only option that CMS cleared for certain E/M services during the COVID-19 public health emergency (PHE) was a boon for medical practices, according to a Part B News analysis of Medicare claims data. While utilization of E/M services that did not have an audio-only option fell 14% between 2019 and 2020, services that were audio-eligible faced just a 3% dip – a considerable win in an overall depressed claims era.
The long-standing challenge of the prior authorization (PA) process, which providers have cited as an impediment to care for years, has not become easier to navigate and still puts patients at harm, industry surveys indicate.


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