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OCR alert addresses human vulnerabilities in social engineering attacks

03/17/2025

The October 2024 Cybersecurity Newsletter from the Office for Civil Rights (OCR) focuses on social engineering — a significant and growing cyberthreat aimed at exploiting individuals to gain unauthorized access to sensitive information.

You need a scorecard to track telehealth coverage in 2025

03/17/2025

by: Julia Kyles, CPC

You know that CMS will not reimburse the new CPT telehealth codes (PBN 1/23/24). However, some commercial plans are picking up the new codes (98000-98015).

Doing the splits: MDM offers more flexibility for split/shared visits

03/17/2025

by: Julia Kyles, CPC

The answers to a reader’s questions about split/shared visits demonstrate that medical decision-making (MDM) can boost your care team’s effectiveness.

Roster billing for hepatitis B — July 2025 release

03/17/2025

by: DecisionHealth staff

On Feb. 21, CMS published Medicare Claims Processing Transmittal 13091 to communicate the roster billing process for submitting Part B claims for hepatitis B vaccines and their administration. CMS recently expanded coverage of hepatitis B vaccinations to include individuals who have not previously received a completed vaccination series and individuals whose previous vaccination history is unknown.

Denial trends favorable on 59-appended procedural services

03/17/2025

by: Richard Scott

Practices upped their use of modifier 59 (Distinct procedural service) in recent years, adding nearly 1 million 59-appended claims to the most frequently reported same-day procedural codes.

In trend, court limits drug rebate AKS charges to easier ‘but-for’ standard

03/10/2025

by: Roy Edroso

A recent ruling on the False Claims Act (FCA) implications of the anti-kickback statute (AKS) appears to be part of a trend that may protect you from escalated penalties if you’re charged with AKS violations.

Compounded GLP-1s set to exit market, ending your ability to prescribe

03/10/2025

by: Roy Edroso

The brisk online market in compounded versions of GLP-1s — less expensive than the first-line, on-patent versions such as Ozempic — are about to lose their FDA shortage authorization. Know the deadlines, which would end your ability to prescribe them.

Pass along knowledge on the new transfer of care rule

03/10/2025

by: Julia Kyles, CPC

Take time to brush up on transfer of care modifiers in the wake of Medicare’s new rule for procedures with a 90-day global period. But be aware that there’s some good news surrounding this update: The final version of the new rule is much simpler than the proposed rule.

Mind your transfer of care modifiers

03/10/2025

by: Julia Kyles, CPC

CMS updated its rules for modifier 54 and reminded providers of the requirements for modifier 55 in the final 2025 Medicare physician fee schedule. While you train staff on the new policy, include a refresher on the full descriptors for the three transfer of care codes. You should also remind them that Medicare and most private payers don’t pay for modifier 56.

Stay in line with HIPAA minimum necessary rule, AI convergence

03/10/2025

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

Question: With the increasing adoption of artificial intelligence (AI) and machine learning (ML) in health care, how can privacy officers ensure compliance with HIPAA’s minimum necessary rule, especially in the context of data anonymization and use for research or analytics purposes?

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