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

03/10/2025

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?

Compliantly relay results on an imaging test via telehealth

03/10/2025

by: Laura Evans, CPC

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.

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