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Maps show spread of independent practice for NPs, PAs

08/31/2026

While the growth in numbers and earning power of nurse practitioners (NP) and physician associates (PA) is impressive, perhaps their most important advance is in state laws allowing them to practice with limited and even no physician oversight (see related story, p 3).

PFS implements law throwing some foreign-born patients off Medicare

08/24/2026

by: Roy Edroso

The “Limiting Medicare Coverage of Certain Individuals” section of the proposed 2027 Medicare physician fee schedule explains how CMS will enforce a 2025 law that removes some Medicare beneficiaries from the rolls based on immigration status as soon as February 2027. If you have patients affected by this, you may not hear that their services are not covered by Medicare until after they’ve been cut — and it’s not clear that your charges on those patients will be allowed.

Monitor the maternity care coding makeover for 2027

08/24/2026

by: Nancy Reading

Start the countdown: Beginning Jan. 1, 2027, services for antepartum care, labor management, delivery and postpartum care will be coded separately. The old global approach to billing obstetric care was intended to simplify billing, but it no longer reflects the variation and complexity of care across the phases of pregnancy.

Once upon a diagnosis: Why coding the patient’s story is vital

08/24/2026

by: April Russell and Diane Pittman

Ever since the International Classification of Diseases (ICD) was introduced, its purpose has been clear: to capture the reason for a patient’s visit across all health care settings. As outlined in the first paragraph of the ICD-10-CM Official Guidelines for Coding and Reporting, diagnosis coding is intended to describe the patient’s condition using terminology that “includes specific diagnoses as well as symptoms, problems, and reasons for the encounter.”

Providers had little trouble taking sides among modifiers 50, LT and RT

08/24/2026

by: Roy Edroso and Julia Kyles, CPC

Deciding whether to use modifier 50 (Bilateral procedure) or modifiers LT/RT (Left side/right side) requires a little forethought and sometimes homework. Still, in 2024, the most recent year of available Medicare figures, it appears providers didn’t do too badly — though some codes proved more of a challenge.

AI may ease the sting of burnout, but real solutions run deeper

08/17/2026

by: Roy Edroso

As physician burnout continues to plague practices, managers may hope that artificial intelligence (AI) innovations such as always-on scribing will relieve the administrative burdens that contribute to it. But experts say the problem goes deeper than a technology fix.

Group services: Confidentiality agreements can negate, not create, compliance risk

08/17/2026

by: Julia Kyles, CPC

CMS covers group services such as medical nutrition therapy (97804) and behavior intervention (96164). Now, CMS has put group services back in the spotlight with its proposed group E/M visit for patients with certain chronic conditions.

J-1 visa rules are changing; watch new deadlines, stay proactive

08/17/2026

by: Roy Edroso

If you have providers who are in the U.S. on a J-1 visa, be aware that the Department of Homeland Security (DHS) is tightening its rules, which some observers believe will force some providers to leave the U.S. before their course of medical study, perhaps sooner than you expected to lose them

More PFS: FQHC, RHC updates plus drug inflation changes

08/17/2026

by: Roy Edroso

Note several additional policy updates contained in the proposed 2027 Medicare physician fee schedule, including market basket rate updates for federally qualified health centers and more.

Monitor modifier 25 red flags: Watch frequency, replication

08/17/2026

by: HCPro staff

Question: What are some red flags associated with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) that might trigger payer audits?

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