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Critical care codes fall hard from COVID boom, resetting trend curve

05/12/2025

Medicare utilization of many CPT codes, such as outpatient E/M codes, took a beating in the pandemic years. But use of the critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and add-on code 99292 ( … ; each additional 30 minutes) jumped higher during that period.

Solidify your substitute physician billing before you take a leave

05/05/2025

by: Julia Kyles, CPC

Vacation season is about to begin. As more physicians head off for a summer break, practices increasingly will report the services of a substitute provider. But whether a physician will be out of the office for vacation, sick leave, maternity leave, paternity leave or any other reason, your practice needs to review the key points for reporting a substitute physician’s — or some physical therapists’ — services.

Patients worried about autism ‘registry’? Encourage them to ‘be heard.’

05/05/2025

by: Roy Edroso

The recent HHS announcement of an autism “registry” caused an outcry and a pullback. It also raised the question: How safe is your vulnerable patients’ data when the government demands it, and what can your patients do, and what should they know, if they have concerns?

Sharpen reporting, documentation strategies for modifier 25

05/05/2025

by: HCPro staff

You can turn to modifier 25 to help secure complete reimbursement for E/M services, but only when reported appropriately.

Open payments ‘review and dispute’ deadline May 15

05/05/2025

by: Roy Edroso

Your final opportunity to respond to the Open Payments data reported against your providers is Thursday, May 15.

Practices rely on locum tenens when physicians take time off

05/05/2025

by: Julia Kyles, CPC

When it is time for physicians to take a break, they are significantly more likely to bring in a fee-for-time provider, formerly known as a locum tenens, than to rely on a reciprocal billing arrangement, according to a review of Medicare Part B claims data from 2013 to 2023.

Watch locum tenens contract terms to guard against rogue providers

04/28/2025

by: Roy Edroso

A traveling nurse convicted of tampering with morphine raises the question: How responsible is your practice for outside clinical providers hired on a freelance basis?

Hefty telemedicine correction adds opportunity, also restricts billing

04/28/2025

by: Julia Kyles, CPC

Download the latest set of technical corrections from the AMA and be ready to share relevant sections when you appeal denials of your telemedicine services (98000-98016).

Defend your psychotherapy revenue from the top down

04/28/2025

by: Julia Kyles, CPC

Whether your practice specializes in psychiatric services or wants to add a specialist to your practice, you must know what’s required for commonly reported services. Your research should start with who performs the services.

Oz, AI and MA: Signs point to more AI, sooner, for CMS

04/28/2025

by: Roy Edroso

Lately CMS has shown an interest in advancing its use of artificial intelligence (AI) in health care — possibly shading more into clinical use. But experts say there are still red lines that even this go-fast administration wouldn’t be likely to cross.

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