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Data breach draws class action suit: Can it happen to you?

04/13/2026

A physician practice had to pony up $2.5 million to settle a class action suit because of a cybercriminal heist of patient information held in its systems. If you have a HIPAA breach, make sure you’re ready for that kind of follow-up.

Telemedicine for workers’ compensation depends on the state and the service

04/13/2026

by: Julia Kyles, CPC

Check state law before you provide telehealth services for a work-related injury or illness. Each state sets its own telemedicine laws for workers’ compensation treatments, including the maximum medical improvement (MMI) evaluation.

APM bonus jumps, but MIPS ‘is here to stay’

04/13/2026

by: Roy Edroso

Congress recently approved a substantial bonus for successful alternative payment models (APM) under the Quality Payment Program (QPP). While CMS has been quiet about the bonus, if you’re in an advanced APM, it ought to brighten up your outlook. But if you’re in the other QPP track and happy with it, experts doubt you’ll be pushed into APMs.

Patient, treatment are factors when you level risk based on a procedure

04/13/2026

by: Julia Kyles, CPC

Consider both the type of procedure and factors specific to the patient when you select the level of risk for an E/M encounter, said Doris Branker, CHC, CPC, CIRCC, CPMA, CPC-I, CANPC, CEMC, president, DB Healthcare Consulting and Education. Her remarks were in response to questions during the 2025 Advanced Specialty Coding Summit: Pain Management, but they apply across E/M coding situations.

Ask probing questions to avoid misusing modifier 59

04/13/2026

by: HCPro staff

Modifier 59 (Distinct procedural service) has been associated with considerable abuse and high levels of manual audit activity, leading to reviews, appeals and even civil fraud and abuse cases. Given the scrutiny of the modifier, it’s vital that coders understand when it’s appropriate to add it to a claim.

Courtesy ABNs dominate, missed ABNs rise, and denials for GA dip sharply

04/13/2026

by: Julia Kyles, CPC

Providers are most likely to issue an advance beneficiary notice of non-coverage (ABN) for services that are excluded from Medicare coverage. For the years 2020 to 2024 providers submitted approximately 574 million claims with modifier GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit).

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