Part B News | Part B News

Switching to concierge? Don’t short-change existing patients

04/14/2025

Question: I’m thinking of transitioning my practice to a membership concierge model, but I suspect many of my current insured patients will object. Would I have to worry about getting sued or sanctioned?

CMS assigned an absolute edit to most new CPT codes

04/14/2025

by: Julia Kyles, CPC

To prevent denials of your claims for new CPT codes, share the final piece of the latest National Correct Coding Initiative (NCCI) update with your team.

HCPCS 2025 first quarter update brings nearly 150 changes

04/14/2025

by: DecisionHealth staff

CMS recently published its HCPCS quarterly update, which brings 148 HCPCS Level II code additions, discontinuations and revisions. The changes, which became effective April 1.

Modifiers tell the tale of audio/video vs. audio-only telehealth service

04/14/2025

by: Julia Kyles, CPC

Telehealth services for Medicare Part B soared under the expansions that were first enacted during the COVID-19 public health emergency and have been extended by Congress several times. The expansions and waivers included coverage of audio-only services, including the popular telephone E/M services (99441-99443), which CMS reimbursed at rates equivalent to an office/other outpatient E/M encounter.

Lab tests score poorly on CERT; use protocols, EHR to beat the spread

04/07/2025

by: Roy Edroso

The latest CERT report shows that you may be skating on lab orders that could get taken back upon post-payment review — mainly because of documentation errors. Take a few simple steps to make sure your claims are clean.

HHS cuts 20,000 employees, closes and combines departments

04/07/2025

by: Roy Edroso

HHS has announced the dismissal of 10,000 employees Department-wide, which takes the official number of cashiered employees so far to about 20,000.

Sharpen audio-only E/M visit documentation and coding

04/07/2025

by: Julia Kyles, CPC

Audio-only telehealth visits are still relevant thanks to another extension of audio-only services from Congress and private payer adoption. Below you will find two recent questions about how to report audio-only visits to private payers. Remember that telehealth coding is an evolving topic; you should watch the plans your practice accepts for new and revised guidance throughout the year.

Tackle risk assessments as cyberthreats continue to threaten

04/07/2025

by: Rebecca Herold, CDPSE, FIP, CISSP, CIPM, CIPP/US, CIPT, CISM, CISA, FLMI

Question: How should privacy officers approach risk assessments in the face of emerging cyberthreats like ransomware, and what best practices can be implemented to ensure both technical safeguards and workforce training align with HIPAA security requirements?

Follow diagnosis, sequencing for ICD-10-CM coding for diabetes

04/07/2025

by: DecisionHealth staff

As the prevalence of diabetes mellitus continues to grow, a keen understanding of the disease can help you keep track of how to code for it. From pre-diabetes to the increasingly common Type 2 diabetes, accurate coding will help keep your claims correct.

Chronic, transitional care management tied to big improper pay rates

04/07/2025

by: Richard Scott

Ensure your coding and documentation accuracy is on target for a host of E/M claims, including chronic care management (CCM) (99490) and transitional care management (TCM) (99495, 99496) that one of CMS’ auditing arms has flagged for improper payments.

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