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ACP use grows, but its trajectory has slowed in recent years

03/09/2026

Since CMS first authorized the advance care planning codes 99497 (first 30 minutes) and 99498 (each additional 30 minutes) in 2016, the services have accelerated in use and generally declined in denials. But they have yet to achieve the strong growth their first years promised.

FCA investigations based on DEI coming; check language, compliance

03/02/2026

by: Roy Edroso

There are signs that the Trump administration is coming after private businesses they consider to be practicing “illegal diversity, equity and inclusion (DEI)” with False Claims Act (FCA) investigations, a technique the government likes to use against health care practices suspected of wrongdoing. No medical targets have been named so far, but it might be a good idea to review your DEI practices to make sure they don’t attract unwanted attention.

Train staff on 3 high-impact changes to lower extremity revascularization coding

03/02/2026

by: Julia Kyles, CPC

Start with the three key changes to the lower extremity revascularization (LER) codes when you train staff on this major update, before you delve into more detailed guidance. The revisions warranted their own presentation during the CPT & RBRVS 2026 Annual Symposium, which brought the following changes to light ...

Subletting a doctor’s office? Make sure you’re covered, not coasting

03/02/2026

by: Roy Edroso

Question: I saw a recent article in the New York Times that discussed, among other things, physicians subletting their or other doctors’ offices. The story had a real estate focus, though, and didn’t get into the legal and regulatory requirements for physicians who do this. What should prospective sublessees be thinking about?

The list of ASM participants is out. Are you in?

03/02/2026

by: Julia Kyles, CPC

CMS is forging ahead with the ambulatory specialty model (ASM), a mandatory quality of care program set to launch Jan. 1, 2027, and run through 2031.

E/M claims shows smooth switch to new telehealth reporting rule

03/02/2026

by: Julia Kyles, CPC

Physicians and advanced practice providers (APP) readily made the switch to reporting telehealth services based on the patient’s location in 2024, the first year it was mandatory for Medicare patients. However, a review of Medicare Part B claims data shows that some providers started to use place of service 10 (Telehealth provided in patient’s home) when it became available for Medicare billing effective April 1, 2022.

Nearly 90% of PCPs hit by drug shortages; prep with inventory control, more

02/23/2026

by: Roy Edroso

The longtime issue of drug shortages persists in medical practice. To better cope, get more proactive about tracking and ordering supplies.

Master modalities, lesion sites when coding fine needle aspiration biopsies

02/23/2026

by: Terry Tropin

The CPT manual includes many types of biopsies: fine needle aspiration (FNA), core needle and skin (tangential, punch and incisional). Some of the guidelines tend to be confusing, particularly those for FNA and core needle biopsies performed at the same surgical session. Cut through the confusion with a clear-eyed look at coding best practices.

Connect the dots between coding and team-based care

02/23/2026

by: Julia Kyles, CPC

Help your clinicians and coders connect on team-based care management and value-based care (VBC) by explaining the role coding plays in treating patients and patient attribution. During the final Q&A session of the CPT & RBRVS 2026 Annual Symposium, a variety of health care professionals who had given presentations on teams-based and value-based care fielded questions from symposium attendees.

OIG releases MA compliance program guidance; watch coding standards

02/23/2026

by: HCPro staff

After releasing its General Compliance Program Guidance in 2023, the Office of Inspector General (OIG) is continuing to deliver supplemental guides geared toward specific subsectors of the health care industry. Released on Feb. 3, the Medicare Advantage (MA) Industry Segment-Specific Compliance Program Guidance (ICPG) details several key risk areas relevant to the MA program and provides recommendations to various parties to mitigate these risks.

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