Part B News | Benchmark of the Week

Modifier 25, highly used, tops $4B in associated payments

10/28/2024

Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) continues to see high utilization. Providers reported it on more than 65 million claims in 2023.

Medicare ranks to rise significantly over 10 years: CBO

10/14/2024

by: Richard Scott

The projected share of individuals under Medicare coverage will grow substantially over the next decade, accruing approximately 23% growth between 2024 and 2034. The Medicare surge is projected to happen while employer-sponsored plans also grow, but Medicaid numbers take a big hit.

Circulatory system disease dominates diagnoses for RPM claims

10/07/2024

by: Julia Kyles, CPC

Providers can use remote physiologic monitoring (RPM) to treat a range of acute and chronic condition. But according to a recent evaluation and inspection report from the HHS Office of Inspector General (OIG), essential hypertension topped the list of primary diagnosis codes on claims for RPM services (99091, 99453, 99454, 99457, and 99458).

Post-PHE telehealth use stayed above pre-COVID levels in Q1 2024

09/30/2024

by: Julia Kyles, CPC

The number of Medicare Part B patients who used telehealth remained above pre-COVID-19 public health emergency (PHE) levels as the one-year anniversary of the PHE’s end approached.

Many low-billing injections, some big-ticket codes in top locum tenens claims

09/23/2024

by: Roy Edroso

The number of claims filed in 2022 with the locum tenens modifier Q6, appended when a substitute provider is practicing under Medicare locum tenens rules, was 3.2 million, a 15% increase from the 2.8 million claims in 2021. Maybe in the last year of the COVID-19 public health emergency, more providers were taking vacations.

Bankruptcies rise among physician practices, bucking the trend

09/16/2024

by: Richard Scott

While the year is not yet out, bankruptcies are hitting the medical practice business harder in 2024 than they did in 2023, climbing a substantial 60% year to year.

Surgical, postop-only claims almost even for transfer of care cases

09/09/2024

by: Julia Kyles, CPC

Billing practitioners who do not treat patients during a procedure’s full global period are slightly more likely to report claims with surgical care-only modifier 54 than with postoperative care modifier 55, according to Medicare Part B claims data.

Modifier 78 continues its slide, though most codes have 0% denials

08/26/2024

by: Roy Edroso

The Medicare billing numbers show a precipitous pandemic-era drop in utilization of modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period). You may have expected that losing trend to slow as America began to recover from the pandemic in 2022. It did, but not by much. The total number of 78 citations slid from 65,857 in 2021 to 51,177 in 2022, a 22% loss.

E/M aches and pains: Just 2 codes would see fee rise in ’25

08/19/2024

by: Richard Scott

The outlook is bleak for most of the 101 E/M codes (99202-99498) available for billing under Medicare Part B in 2025. Just two codes in the E/M series are on track to see a positive shift in reimbursement, and one of those gainers is up a scant $0.03 year-to-year, according to an analysis of the proposed 2025 Medicare physician fee schedule.

Telehealth by mental health providers surged while other specialties slipped

08/12/2024

by: Julia Kyles, CPC

Providers from three specialties broke the trend for Medicare Part B telehealth services, based on claims data submitted by the 10 specialties that reported the highest volume of telehealth services in place of face-to-face encounters in 2020, 2021 and 2022.

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