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With WISeR demo, CMS adds prior auth for Medicare services in six states

07/14/2025

After earlier reforms that sought to reduce the impact of prior authorization on providers and patients, CMS has created a demonstration model that will add prior authorization for regular Medicare for a select group of regional providers.

HIPAA reproductive care PHI overturned, but law still mostly protects it

07/14/2025

by: Roy Edroso

Most of a Biden era reproductive health HIPAA policy has been stopped by a federal court decision. Be clear, though, about your remaining duties to safeguard this kind of protected health information (PHI).

Check Aetna policy if you see unexpected ultrasound, injection denials

07/14/2025

by: Julia Kyles, CPC

When Aetna is the patient’s insurer take a close look at the ultrasound policy before the practice reports 76942 (Ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging supervision and interpretation with treatment for acute or chronic pain), or services that include ultrasound.

Written protocol for inappropriate behavior, however mild, can help

07/14/2025

by: Roy Edroso

Question: We have a patient who sometimes brings gifts such as flowers or candy to his provider. The provider has shared with us that she finds this awkward and has asked him to stop, but the patient persists. We have a harassment policy, but it seems like overkill to bring it to bear here. What should we do?

The doc’s practice did the imaging test. Can we still count it toward MDM?

07/14/2025

by: Laura Evans, CPC

Question: How would you count the following tests toward medical decision-making (MDM) in the following two scenarios?

The physician orders an MRI at today’s visit for the patient’s right ankle. His practice performs the MRI three days later and bills the professional and technical component.
The physician orders a CT scan at today’s visit for the patient’s right ankle and the CT is performed on the same date by the physician’s practice, which then bills the professional and technical component for the scan...

PCPs embraced new prolonged service, chronic pain in 2023

07/14/2025

by: Julia Kyles, CPC

Higher-than-average reporting and relatively low denial rates indicate smooth adoption of several new HCPCS G codes that were introduced in 2023. In addition, a few specialties took the lead in using the new codes, according to the latest Medicare Part B claims data.

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