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Coding message forums can be a source of help, but watch compliance risk

05/04/2026

Medical coding message forums can help coders find the answers to tough coding scenarios and keep claims moving. But remind everyone on your team to make sure their request for help doesn’t create compliance risks or endanger their employment.

05/04/2026

by: Roy Edroso

A new proposed rule covering interoperability and prior authorization for drugs would, essentially, impose prior authorization requirements on payers in major federally funded health care programs for outpatient drugs. These proposed requirements are similar to those imposed by the 2024 final rule for non-drug items and services — except this rule is a tad more friendly to providers.

Updated NPPs raise new compliance, documentation challenges

05/04/2026

by: Dom Nicastro

HHS recently released updated model notices of privacy practices (NPP), introducing changes that go well beyond revising standard privacy notice templates. The recent update includes revisions to the health care provider and health plan NPPs, as well as the Part 2 patient notice.

Discern variations in coding procedures for the middle ear

05/04/2026

by: HCPro staff

Understand the ins and outs of coding procedures for the middle ear to ensure that you’re capturing the work taking place — and the CPT code associated with it. From tympanoplasties to tympanostomies, middle ear procedures can take multiple variations depending on scope of work, and code choice must follow suit.

Denials for modifiers 93, 95 flag errors you should check

05/04/2026

by: Julia Kyles, CPC

Watch the claims results associated with telemedicine modifier 95 and audio-only modifier 93: The denial rates for high-volume codes and places of service raise caution signs for each of them.

Looming form changes mark a good time to review ABN rules

04/27/2026

by: Roy Edroso

The deadline for a switch to new advance beneficiary notice forms (ABN) is coming. It’s a good time to review the do’s and don’ts for these often-misunderstood forms.

Protect revenue, ensure patient eligibility access update in HETS

04/27/2026

by: Julia Kyles, CPC

If your practice relies on software, a billing company or other third-party vendor to perform patient eligibility checks, you’ll hit a revenue roadblock if you don’t enroll those vendors in the HIPAA Eligibility Transaction System (HETS) by May 11, experts warn.

First entrants in ACCESS tech-assist program announced

04/27/2026

by: Roy Edroso

Just three months after announcing its Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, designed to pair tech-enabled partners with Medicare providers and pay them based on medical outcomes, CMS has revealed the first 150 partners accepted to participate.

Broad expansion proposed for sepsis ICD-10-CM coding

04/27/2026

by: HCPro staff

At the public ICD-10-CM Coordination and Maintenance Committee Meeting held March 17-18, CDC’s National Center for Health Statistics (NCHS) discussed a draft proposal involving a broad expansion of sepsis diagnosis coding.

ICD-10-CM updates: How to code for patients with diabetes in remission

04/27/2026

by: HCPro staff

Question: Can you explain when it is appropriate to use the recently added ICD-10-CM code for diabetes in remission?

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