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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).

Does HHS rule spell end of medical faxes? Not quite, experts say

04/06/2026

by: Roy Edroso

A new administrative simplification rule from CMS may finally spell an end to a longstanding, and arguably outdated, method of communication — fax machines. But the fine print suggests that the phase-out may take a while.

Start review of ultrasound AAA requirements with diagnosis codes

04/06/2026

by: Julia Kyles, CPC

A recent change request serves as a reminder to review guidelines for the preventive ultrasound abdominal aortic aneurysm (AAA) screening. This service can save a patient’s life, but the strict requirements make it ripe for mistakes and medical necessity denials.

Remind surgeons that NCCI rules for post-op pain management still apply

04/06/2026

by: Julia Kyles, CPC

Question: I work for a group of surgeons that wants to start billing for post-operative pain blocks. For example, a transversus abdominis plane block (64486-64489) for hernia repair or an intercostal block (64420-64421) for post-mastectomy pain. In the past they’ve asked the anesthesiologist to perform the service, but they claim that they can bill Medicare under a new rule designed to reduce the use of prescription opioids to manage post-operative pain. Is that correct?

Fixate on fracture coding: Follow documentation to ensure accuracy

04/06/2026

by: DecisionHealth staff

For CPT and ICD-10-CM coding of fracture treatment, coders — particularly those in orthopedic practices — need to identify several vital pieces of information from the physician’s note. Ensure you are incorporating key pieces of information and other tips to guarantee accurate coding of fracture treatment.

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