Critical care: Split/shared claims rose, unrelated encounters stayed flat

Why This Topic Matters

The article highlights how Medicare claim patterns have changed over time for critical care services and why understanding reporting trends and payer policy alignment matters for compliance and claim management.

Article Sections

1. Benchmark of the week

   A brief data-focused overview of recent Medicare Part B claim trends for critical care services. It frames the article’s comparison of split/shared reporting and unrelated encounter reporting over time.

2. Claims trends for critical care services

   A discussion of Medicare Part B claims patterns across a three-year period, including shifts in reporting volume and how the trends compare across different categories of critical care services.

3. Modifiers FS and FT in Medicare policy

   Background on the CMS modifiers referenced in the article and their relationship to split/shared and unrelated encounter reporting under Medicare policy. The section also notes the policy context in which the modifiers were introduced.

4. Specialty and denial patterns

   An overview of claim and denial patterns by specialty, with emphasis on the leading specialties reported in the analysis. It also addresses the broader compliance concern of aligning billing practices with Medicare contractor guidance.