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10/12/2026
It may have been years since you thought of COVID relief funds, but are you sure you’ve fulfilled your COVID loan and grant obligations? Government prosecutors are still coming after some recipients and charging fraud. Make sure your records and payment history are buttoned down in case they come for you.
10/12/2026
Questions swirl as physician practices wait for CMS’ final decision on the modifier 25 proposal that the agency announced within the proposed 2027 Medicare physician fee schedule. For further insight, Part B News reached out to Greg Field, CEO of Jiro Health, which recently published an analysis of the proposal’s potential financial impact.
10/12/2026
Practices must be on the defense as auditors and investigators use artificial intelligence (AI) to enhance the computer systems that hunt for signs of health care fraud. And it isn’t just the government that is using AI to scour providers’ data.
10/12/2026
CMS recently released its 2026-2027 seasonal influenza and COVID-19 vaccine pricing file, providing updated Part B payment allowances for several COVID-19 vaccine products.
10/12/2026
Question: We were audited recently for 10 claims where the patients received Durolane, specifically, and all 10 claims were denied for lack of medical necessity. A customer service representative told me that the documentation had to provide quantifiable evidence of pain reduction and/or increased range of motion for a repeat injection. I don’t know what would be considered adequate demonstration of medical necessity for an initial injection. Medicare can’t tell me...
10/12/2026
Practices that frequently report claims with modifier 25 could be on the short end of a massive redistribution of professional fees in CY 2027. In the balance hangs nearly $900 million in payments, according to analysis from Jiro Health.

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