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Benchmark of the Week
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.
After stalled growth in 2020, practices lived through a modest recovery in utilization in 2021. For payments, however, it was a banner year.
Thanks to popular media, the public may think that physicians and nurses who specialize in emergency medicine are the only providers who work in the emergency department. But the latest Medicare Part B data for emergency department E/M visits (99281-99285) reveals that members of any specialty can and do provide emergency department services.
Despite a non-payable status under Medicare, a series of six codes that reflect care provided during irregular or emergency hours garnered hundreds of thousands of claims – and returned zero dollars – in 2021.
The modifiers 52 (Reduced services) and 53 (Discontinued procedure) often confuse providers. While total utilization remains low – 184,489 claims with 52 in 2021 and 30,850 for 53 the same year – your personal patterns may warrant another look, particularly if your practice performs a lot of the tests and exams that make up the bulk of services tied to these claims.
One critical factor in physicians’ decisions to use new medical technology is a concern that the new tech may expose the physician or practice to liability claims.
Five specialties added new E/M remote physiologic monitoring (RPM) services to their practices in 2019 and continued to increase reporting in 2020. Internal medicine was at the head of the pack in 2019 and stayed there in 2020, according to a review of Medicare Part B data for 2019 and 2020, the latest available.
Many psychotherapy services dipped in 2020; however, the 60-minute therapy service code gained claims while Part B payments grew by $28 million. And aside from psychiatric specialists, nurse practitioners were most likely to report a psychiatric diagnostic evaluation when also performing a separate E/M service.


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