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06/23/2025
While all Medicare providers should be interested in the prospective change to physician payments in Congress’ pending budget bill, there are a few other pieces of the bill that would affect them indirectly. Medicaid and Affordable Care Act (ACA) cuts, for example, appear to increase the number of uninsured and threaten at-risk hospitals. Also, the sequestration cut isn’t going up — or going away.
06/23/2025
Make sure you incorporate current CMS coding guidance for three preventive services into your workflow and check for denials that might be candidates for an appeal.
06/23/2025
Question: Our providers have started to perform some services that are 100% patient pay, such as platelet rich plasma injections to treat pain. Do we need a separate policy for documenting services when the record doesn’t need to support a code?
06/23/2025
Upcoding is becoming a more common practice across all outpatient settings, according to a recent Trilliant Health report.
06/23/2025
Analysis of Medicare Part B claims data indicates that when practices bring in a substitute physician, they favor the fee-for-time arrangements over reciprocal billing arrangements. A closer review of the claims data reveals the specialists who are most likely to bring in a substitute when they take time off.
06/16/2025
Start training your staff on the diagnosis code changes that will go into effect Oct. 1. CMS will adopt the ICD-10-CM additions, revisions and deletions that it previewed in April.
06/16/2025
CMS continues to update the National Correct Coding Initiative (NCCI) database with procedure-to-procedure (PTP) edit pairs, featuring new telemedicine, pain block and carrier-priced ECG codes. The more than 29,000 new PTP edits will go into effect July 1.
06/16/2025
A major AMA survey finds a continued decline in practices owned by their physicians — though all is not lost for those that wish to maintain their independence. 
06/16/2025
Question: How would you summarize the key proposed changes to the HIPAA Security Rule, and why are these updates significant for health care organizations?
06/16/2025
Amid the ongoing decline of private practice ownership, provider groups point to one determining factor that overshadows the rest: the desire to hold better negotiating power with their payers.

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