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Compliantly relay results on an imaging test via telehealth

03/10/2025

Question: If an orthopedist is providing MRI results via telehealth, is this billable? During the COVID-19 public health emergency (PHE) it seemed like we were able to do that as long as it was medically necessary. But would this still be true in 2025?

Kennedy seeks to end public comment process for HHS, CMS rules

03/10/2025

by: Roy Edroso

Robert F. Kennedy Jr., the new HHS Secretary, released a policy statement, previewed on Feb. 28 and published at the Federal Register on March 3, announcing the Department’s intention to forego the “notice and comment rulemaking procedures” it had adopted 54 years earlier.

Recent slide in transfer of care modifiers continues

03/10/2025

by: Roy Edroso

After an early-pandemic freefall, the modifiers associated with transfers of patient care — 54 (Surgical care only), 55 (Post-op management only) and 56 (Pre-operative management only) — seemed to be climbing back in utilization. But the latest Medicare numbers, from 2023, suggest that they’re backsliding.

NPs on track for huge growth, but can the 'extenders’ deliver on revenue?

03/03/2025

by: Roy Edroso

Nurse practitioners continue to enjoy growth in employment and scope of practice, which should keep the salaries high. But for some types of practice, their contributions are worth the added expense.

Boost productivity, reduce strife with internal coding policies

03/03/2025

by: Julia Kyles, CPC

In an ideal world there would be a clear, official answer to every coding question that comes up in your practice, but coding is full of grey areas. When official guidance doesn’t help, an internal policy can reduce arguments and boost productivity by giving coders and treating providers clarity on how to document and code in situations where there is no clear answer, or there’s a contradiction in the guidance.

Follow CMS rule, not CPT guidance when you report modifier 99

03/03/2025

by: Julia Kyles, CPC

Train new coders to follow CMS’ rules when they find CPT guidance that doesn’t match Medicare’s requirements.

Bird flu, measles spread: If you’re nearby, take precautionary steps

03/03/2025

by: Roy Edroso

Flu season has a few distressing added wrinkles this year. Keep your eye on two disease outbreaks that have health officials on high alert in several parts of the country, and make sure your infection control is tight.

MACs finalize uniform LCD to limit sacroiliac fusions starting April 17

03/03/2025

by: Laura Evans, CPC

Practices in 22 states covered by three Medicare administrative contractors (MAC) should prepare for coverage to be halted in April for minimally invasive sacroiliac fusion procedures that do not include placement of transfixation devices across the joint.

Practices rolled with code revisions, saw slight uptick in denials

03/03/2025

by: Julia Kyles, CPC

Keep an eye on denials when you report a revised code even when your overall reporting of the service decreases. That’s one lesson to draw from Medicare Part B claims data for 2023, the latest data available.

Prevent harm to staff and patients — and your practice — with tight security

02/24/2025

by: Roy Edroso

Practice security is paramount not only for patients but also for staff. If they’re your first line of defense, they have considerable exposure if trouble walks in. It’s important to consider their safety, for legal as well as humanitarian reasons.

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