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Benchmark of the Week
The Part B professional fee payment for the delayed creation of an exit site for an embedded catheter (49436) has increased 185.8% in 2023, making it the biggest gainer among the codes covered by the Medicare physician fee schedule that went into effect January 1.
Following the pandemic-induced sag in patient encounters in 2020, nurse practitioners nearly returned to pre-COVID levels in 2021 — and with federal dollars buoying E/M services, their payments roared to new heights.
Emergency department visits (99281-99288) topped the list of services that triggered a request for an independent dispute resolution (IDR) during the second and third quarters of 2022, according to a report on the newfangled payment dispute process.
Despite much CMS fanfare, the Medicare Diabetes Prevention Program (MDPP), never very popular to begin with, continued its dismal utilization numbers in 2021. Medicare’s other, less heralded diabetes education services, diabetes self-management training (DSMT) and medical nutrition therapy (MNT), have done better, but still took a hit in the pandemic.
Practices are on the verge of stepping up their denials management strategies in 2023 as Medicare Part B rate cuts are expected to impact revenue. On the delivery side, most practices plan to continue their telehealth operations in the new year.
A CMS plan to streamline the prior authorization process for certain payers would slash the amount of time spent chasing approvals and save providers billions.
Providers are increasingly likely to help patients navigate their advance directives and other pieces of the advance care planning (ACP) set of services, and reimbursement is climbing accordingly.\
When Part B News looked at the “Impact on CY 2022 payment for selected procedures” that came with the physician fee schedule last year, there was not a single rate gainer among the 23 codes with non-facility rates. Flash forward to that list for 2023, and you’ll find that – with one significant exception – the situation is even worse.
Practices will experience a spike in denials for prolonged services in 2023 if they aren’t prepared for the next round of coding updates. Medicare Part B claims data show that denials for prolonged services by physicians and qualified health care professionals (QHP) in the outpatient setting (99354 and 99355) increased from an average of 10% in 2020 to an average of 30% in 2021.
The number of specialties welcoming a boost to their allowed charges in 2023 is far outpaced by those facing projected cuts, according to relative value unit (RVU) revisions announced in the final 2023 Medicare physician fee schedule released Nov. 1.


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