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Payment fix fails under Trump; practices urged to diversify, cut back

03/24/2025

The most recent continuing resolution (CR) from Congress, signed by President Trump on March 15, re-ups a few Medicare regulatory fixes providers had been hoping for, including COVID-era telehealth flexibilities, through September 2025. But once again Congress failed to adjust Medicare physician fee schedule pay rates, leaving many providers scrambling to meet their own budgets.

Use 2 quick questions to test your team’s G2211 knowledge

03/24/2025

by: Julia Kyles, CPC

Code G2211, often known as the complex E/M visit, can add about $14 to your E/M office visits. But the service is generating confusion about when to report it and who can report it. Use this quick quiz to test your coding and billing teams’ knowledge.

Guard against provider-on-patient assault with screenings, staff prep

03/24/2025

by: Roy Edroso

Reports of health providers accused or convicted of patient assault show that practices can’t insulate themselves completely from criminal actions of their clinical staff, but you can take steps to reduce the chances of such incidents, and to shore up your defense in their event.

CMS says it will axe primary care, other CMMI innovation models

03/24/2025

by: Richard Scott

Medical groups will see the early termination of several payment models from the Center for Medicare and Medicaid Innovation (CMMI), including two primary care-focused models, an end-stage renal disease (ESRD) model and a Maryland-specific program.

Avoid absolutes when selecting the level of risk for MDM

03/24/2025

by: Julia Kyles, CPC

Question: When calculating risk for an E/M visit, is total parenteral nutrition (TPN) moderate risk or high risk? We found some sources that state it should be compared to prescription drug management, which would be moderate risk. Other sources say it should be compared to drug therapy requiring intensive monitoring for toxicity, which is high risk.

Review the full descriptors for patient relationship modifiers X1-X5

03/24/2025

by: Julia Kyles, CPC

CMS introduced patient relationship modifiers in 2018. Even though they are not mandatory, reporting of the modifiers continues to increase, particularly with modifier X5 (Diagnostic services requested by another clinician). Here are the full descriptors for each code.

Position may influence denials on patient relationship modifiers

03/24/2025

by: Julia Kyles, CPC

Look at your claims with patient relationship modifiers X1-X5 and move the modifier to the second position if you’re seeing high denials.

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