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Benchmark of the Week
12/09/2024
The conversion factor shave of -2.8% will have a fee-slashing effect on many services in 2025. Due to relative value unit (RVU) adjustments, some codes will net a fee increase next year. But all of the high-volume codes, as labeled by CMS and shown in the chart below, are on pace for reductions in both non-facility and facility settings.
11/25/2024
In the rates for Medicare-payable services codified in the physician fee schedule final rule, losers outpace winners — and the winners aren’t doing so well, either.
11/18/2024
You’ve read about the coming 2.8% pay cut that is on deck for 2025. However, a closer look at specific codes reveals that the impact of the cut will vary across services that are covered under the final 2025 Medicare physician fee schedule.
11/11/2024
Take note of relative value unit (RVU) changes for specialty-specific services within the final 2025 Medicare physician fee schedule. The projected gains in allowable charges for select specialty groups in 2025 are led by clinical social workers (+4%), clinical psychologists (+3%) and anesthesiology providers (+2%), who will see the biggest RVU gains on net.
11/04/2024
Part B providers reporting inpatient and observation care codes appeared to face minor but notable headwinds as they adapted to the AMA’s revised reporting guidelines in 2023. Payments increased for some of the oft-reported codes in 2023, but denial rates also crept up for some of the most-billed services.
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.
10/21/2024
The 2023 Medicare utilization numbers for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) are in, and the results show all of them up from the previous year, with some services rising sharply.
10/14/2024
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.
10/07/2024
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).
09/30/2024
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.

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