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Benchmark of the Week
Clinical social workers, psychologists and podiatrists are among 11 specialty groups slated to receive additional payments for their services in 2018, according to projected allowed charges contained in the proposed 2018 Medicare physician fee schedule.

Denial rates on key vaccine codes from 2013 to 2015, which are the most recent years for Medicare data, have been remarkably consistent and suggest that billing problems with some codes are due to long-known issues. The data also suggest many practices just haven’t caught on yet.

Practices trimmed their denial rates associated with a suite of six debridement codes that they billed more than 3 million times in 2015, which is the latest year of available Medicare claims data.

If past performance is anything to go on, the merit-based incentive payment system (MIPS) will see participation grow at a brisk clip over the next several years.

You can give yourself a pat on the back for your drug-code billing — many of the most-reported drug codes showed low denial rates over calendar years 2014 and 2015.
Maybe practice makes perfect. Some specialties that billed new patient office E/M codes more than a million times in 2015 actually did well with them, compared with the generally high overall denial rate for those codes.

Modifier 78 (Unplanned return to the operating/procedure room by the same physician) is a tough one to get accepted by Medicare contractors. In fact, an analysis of the most recent Medicare data available shows the aggregate denial rate for codes with 78 was 83%. But some codes do much better with it than others.

Rising claims for the screening of hepatitis B virus (HBV) may have received an additional jolt after CMS expanded eligibility criteria to include more patients.

Most of the new CPT/HCPCS codes CMS added in 2015, the most recent year for which we have Medicare data, were not particularly lucrative — but some of them became very popular.

During the three-year span from 2013 to 2015, providers generally achieved an increasing degree of success when reporting post-op E/M services with modifier 24 (Unrelated E/M service by the same physician during a postoperative period).


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