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Stick to your documentation standards for self-pay services

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?

Study: Higher upcoding rates seen across outpatient settings

06/23/2025

by: HCPro staff

Upcoding is becoming a more common practice across all outpatient settings, according to a recent Trilliant Health report.

Primary care, oncology specialties dominate substitute physician services

06/23/2025

by: Julia Kyles, CPC

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.

Introduce staff to new ICD-10-CM codes, tabular update for FY2026

06/16/2025

by: Julia Kyles, CPC

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.

CMS focuses on more new codes in the July 1 NCCI update

06/16/2025

by: Julia Kyles, CPC

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.

AMA survey: Private practice keeps declining; hospitals pick up

06/16/2025

by: Roy Edroso

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.

HIPAA Q&A: Take a deep dive into Security Rule proposed changes

06/16/2025

by: Dom Nicastro

Question: How would you summarize the key proposed changes to the HIPAA Security Rule, and why are these updates significant for health care organizations?

Payer negotiations, burden fuel private practice selloff

06/16/2025

by: Richard Scott

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.

To ease doctor-departing woes, write careful terms into the contract

06/09/2025

by: Roy Edroso

If you’re worried that one of your employed physicians will want to leave before their contract expires, be aware that the best time to handle that problem is when they first sign on. Also, remember that “I quit” isn’t always the end.

Budget bill would peg physician pay to MEI; might mean raise in 2026

06/09/2025

by: Roy Edroso

The budget bill passed on May 22 in the U.S. House of Representatives, now being considered by the Senate, has a proposed change to the physician fee schedule conversion factor (CF) that, while it doesn’t appear to do anything about low reimbursement rates in 2025, promises some relief in 2026 and possibly in years to follow. But experts caution that the gains may not be what they at first appear.

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