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Final NCCI update of 2025 includes PTP edits for new codes
09/29/2025
by: Julia Kyles, CPC
Take note of the new coding edits that will go into effect for your Medicare claims Oct. 1, the same day you’ll flip the switch on the FY2026 ICD-10-CM update. You’ll find 1,821 new bundling edits, including those that feature codes that went into effect this year, in the final National Correct Coding Initiative (NCCI) update of the year.
Without congressional action, the end is nigh for telehealth expansions
09/29/2025
by: Julia Kyles, CPC
After five years, most — but not all — of Medicare’s telehealth expansions are scheduled to end at midnight, Oct. 1. Even though one quarter of eligible Medicare patients continue to take advantage of the broader telehealth benefit, it seems unlikely that Congress will pass another last-minute extension or a permanent upgrade to Medicare telehealth law to keep the popular policies in place.
Looming ACA cuts may push patients out of coverage, strain revenue
09/29/2025
by: Roy Edroso
Barring last-minute congressional intervention, the 2026 budget bill will cause a steep rise in Affordable Care Act (ACA) plan premiums. Practices with a lot of those beneficiaries as patients should plan for reduced visits and revenues.
Dissect CPT coding for mental health services, get team buy-in
09/29/2025
by: HCPro staff
Medicare coverage of mental health services has expanded significantly in recent years. Along with authorizing payment for additional services and telehealth options, CMS has established several new provider types.
Top of the class: An add-on code outpaced services introduced in 2024
09/29/2025
by: Julia Kyles, CPC
The top new service of 2024 was an E/M add-on code that paid approximately $23 when it was introduced. Analysis of the latest available Medicare Part B data shows that pelvic examination code 99459 topped the list of CPT service codes that went into effect Jan. 1, 2024. The code also ranked in the top five for submitted charges.
Preventive measures, appropriate responses reduce litigation risks
09/22/2025
by: Julia Kyles, CPC
You’ve educated your staff on how to recognize the warning signs that a patient is litigious. You’ve emphasized that they should communicate their concerns to a supervisor or practice owner. Your next step is to give your team more guidance on what to do when they believe a patient is likely to sue the practice, has threatened to sue, or is currently suing the practice.
Failed restrictive covenant case signals a warning to practices
09/22/2025
by: Roy Edroso
Recently a New Jersey practice lost a suit to enforce a restrictive covenant against a physician they had released. Experts say the case reveals pitfalls that practices should take care to avoid when they write and enforce their noncompetes and other covenants, and ways to get around them if they still come up.
Survey says docs feel MD shortage; go for young recruits, high engagement
09/22/2025
by: Roy Edroso
A Medscape survey of 1,001 physicians suggests that the shortage of health care providers in the U.S. is being felt keenly at ground level, with doctors lamenting a lack of sufficient “qualified applicants” to relieve it. Experts suggest luring recruits with relevant offers and engagement.
E/M office visit payments fall to four-year low, despite high-level code climb
09/22/2025
by: Richard Scott
Higher-level E/M office visit codes for established patients continued to climb in 2024, with significant growth for Level 4 and 5 codes. Yet total payments for the office visit suite (99202-99215) were at their lowest levels in four years.
Beware of signs of lawsuit-prone patients, and keep documentation professional
09/15/2025
by: Julia Kyles, CPC
Train everyone in your practice to take a preventive approach to litigious patients, meaning patients who threaten to file complaints or sue for any reason or no reason at all. Everyone in the practice, from the scheduler to the surgeon, needs to recognize the signs and know how to communicate their concerns about a patient so they don’t make a bad situation worse. The approach also works for patients who are merely difficult and reasonable patients who are considering a lawsuit.
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