Part B News
Brace for tariff impact on lab equipment, syringes, PPE and more
06/02/2025
by: Roy Edroso
Heads up: While President Trump continues to alter the tariffs he announced in February, it’s likely that some of your equipment prices will be affected, and you should prepare for cost fluctuations.
CMMI pivots include ‘inferred risk,’ possible end of no-risk ACOs
06/02/2025
by: Roy Edroso
A white paper, press release, and interview with the new director of CMS’ Center for Medicare and Medicaid Innovation (CMMI) suggest significant changes to innovation and accountable care models such as the Medicare Shared Savings Program (MSSP) and to Medicare Advantage.
Wrap in lessons small practices can learn from 3 enforcement actions
06/02/2025
by: Julia Kyles, CPC
A trio of recent enforcement actions related to corporate integrity agreements (CIA) contains teachable moments for small groups and solo provider practices.
Adopt best practices for documenting bacterial culture lab tests
06/02/2025
by: DecisionHealth staff
CMS determined the improper payment rate for bacterial culture lab tests was 15.1% in 2023, with a projected improper payment amount of $9.6 million. Insufficient documentation accounted for 100% of improper payments for these tests during this reporting period, according to the agency.
Top psych codes endured post-COVID slump, with one exception
06/02/2025
by: Julia Kyles, CPC
Most high-utilization psychiatry codes revealed symptoms of the COVID-19 slump that hit other services. However, denials for many services increased after a dip in 2020. A review of Medicare Part B data for the years 2019 to 2023 identified several top primary psychiatry codes.
Physician associates continue to rise, in price and in prestige
05/19/2025
by: Roy Edroso
New findings from the American Association of Physician Associates (AAPA) show that PAs remain a growth industry — not only in number and compensation, but also in independent practice.
Decode the independent interpretation of tests for E/M coding
05/19/2025
by: Julia Kyles, CPC
Make sure your staff know when they can count the independent review of a test toward medical decision-making (MDM). Independent interpretation of a test can lift the level of the “amount and/or complexity of data to be reviewed and analyzed (data)” element of an E/M visit to moderate or extensive, depending on the work performed for an encounter.
Trump tries ‘Most Favored Nation’ drug pricing again, this time with Part D
05/19/2025
by: Roy Edroso
On May 12 the Trump administration announced a revival of the “Most Favored Nation” (MFN) drug pricing executive order (EO) similar to one it unsuccessfully tried to implement in President Trump’s first term. Apart from including Part D drugs and some more aggressive language than last time, administration officials did not immediately say how this attempt would achieve a different result.
Double down on risk analysis with support tools, workflow flexes
05/19/2025
by: Dom Nicastro
A recent enforcement action by the HHS Office for Civil Rights (OCR) highlights the consequences of failing to conduct an adequate risk analysis under the HIPAA Security Rule.
Claims jump 17% for PA established office visits over 5 years
05/19/2025
by: Richard Scott
Physician associate (PA) billing boomed in a recent five-year stretch, as total claims climbed dramatically and the frequently reported E/M office visits (99211-99215) surged to new highs.
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