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Denial rates mostly up on top 59-appended codes

02/23/2026

Of the top 15 codes that practices reported with modifier 59 (Distinct procedural service), only a handful saw positive movement in denial rates between 2023 and 2024, and lesion-destruction codes once again fronted the list.

Telehealth waivers secure through 2027, watch controlled Rx deadlines

02/16/2026

by: Julia Kyles, CPC

Medicare patients can continue to receive telehealth services from home for the next two years, thanks to the latest extension of popular waivers that were introduced during the COVID-19 public health emergency.

ACO REACH to become LEAD, with more features, high-needs patient care

02/16/2026

by: Roy Edroso

Having converted from CMS’ Direct Contracting model in 2023, ACO REACH is converting again by 2027 to a model called Long-term Enhanced ACO Design, or LEAD. Details are still emerging but CMS promises, and experts expect, that the new model will expand REACH’s appeal to smaller practices, particularly those with high-needs populations.

Open Payments update is a reminder to keep records, dispute mistakes

02/16/2026

by: Julia Kyles, CPC

The January Open Payments update shows an uptick in the number of disputed records. That’s a reminder that covered recipients, including physicians and non-physician practitioners (NPP), should check the information that group purchasing organizations, pharmaceutical companies and medical device companies report to CMS before the agency publishes it.

Know when add-on behavioral codes apply to the APCM code set

02/16/2026

by: HCPro staff

Question: How has the 2026 Medicare physician fee schedule final rule, effective Jan. 1, 2026, affected coding of advanced primary care management (APCM)?

Contractor medical director: Cloned time may ‘raise red flags during audits’

02/16/2026

by: Julia Kyles, CPC

Documenting the same time for every patient encounter can raise red flags during audits and increases risk for practitioners. Those warnings were issued during the CPT & RBRVS 2026 Annual Symposium’s question and answer session for Medicare contractor medical directors (CMD).

To stop embezzlers, guard your figures, and let them know you’re watching

02/16/2026

by: Roy Edroso

More big embezzlement charges against medical practice managers serve as a reminder that it’s too easy for a practice to lose money when basic safeguards aren’t in place.

Small rise in Open Payments to MDs in 2024, but NPPs leapt high

02/16/2026

by: Roy Edroso

CMS’ Open Payments website has undergone a makeover, and its latest (2024) numbers for payments to physicians from “applicable manufacturers or applicable GPOs” (including drug and device manufacturers) are available there. More money changed hands in 2024 than in 2018, the earliest year for which numbers are publicly available. But it may be less than you expected.

Under-1% proposed rate rise, risk adjustment crackdown fret MA payers

02/09/2026

by: Roy Edroso

An exceedingly modest proposed rate increase for Medicare Advantage payers may signal the end of the Trump administration’s Medicare Advantage honeymoon. It also could forecast a threat to provider payments, as well as higher premiums and more cuts to the benefits of beneficiaries.

Follow 3 steps when you report an assistant-at-surgery modifier

02/09/2026

by: Julia Kyles, CPC

Take three steps when an assistant surgeon helps during a procedure. First, make sure an assistant at surgery modifier is appropriate for the procedure. Second, make sure the primary surgeon’s note explains why they needed the help of a qualified health care professional (QHP) or another physician for the procedure. Third, make sure you select the correct modifier, based on the assistant’s credentials and role.

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