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Drug drops: Amazon’s One Medical offices to feature pharmacy kiosks
10/20/2025
by: Roy Edroso
Amazon has announced that, in selected cities, its One Medical offices will soon have Amazon Pharmacy kiosks to dispense its providers’ prescriptions. It marks an intriguing new model for provider-pharmacy cooperation, though the situation may be difficult for other companies or even Amazon to replicate elsewhere.
Defined roles, not length of note, support split/shared billing
10/20/2025
by: Julia Kyles, CPC
You know that Medicare’s split/shared rule allows practices to bill E/M visits in the facility setting under the physician’s name and identification number when a qualified health care professional (QHP) performs part of the encounter and the physician performs the substantive portion of the work for the encounter. However, the documentation must clearly show how the providers divided their work.
Critical care: Split/shared claims rose, unrelated encounters stayed flat
10/20/2025
by: Julia Kyles, CPC
Three years of data for critical care services (99291-99292) showed a steady increase for split/shared critical care services. Over the same period critical care services during a procedure’s global period stayed flat.
Shutdown slows claims, blocks telehealth; plan now, alert patients
10/13/2025
by: Roy Edroso
Like previous federal government shutdowns, the one that ensued when Congress failed to produce a continuing resolution (CR) on the budget by Oct. 1 has implications for providers. You should reduce the chances of harm by planning to address them now.
MACs for 38 states mull uniform LCD, this one for peripheral blocks
10/13/2025
by: Julia Kyles, CPC
A new draft local coverage determination (LCD) reminds practices to keep an eye on their Medicare administrative contractor’s (MAC) LCD activity. Based on the proposed LCD and several existing uniform LCDs for pain management, when MACs team up, the new policy is always stricter than the LCD it will replace.
LCDs and dates for ‘peripheral nerve blocks and procedures for chronic pain’
10/13/2025
by: Julia Kyles, CPC
Practices in 76% of the U.S. will be subject to a new, strict local coverage determination (LCD) for chronic pain treatments if five Medicare administrative contractors implement a proposed LCD. 
Wrap in recent updates to CMS’ preventive services tool
10/13/2025
by: HCPro staff
Don’t miss updated coding guidance that can be found in CMS’ Medicare preventive services educational tool for several services.
How to accurately capture and code chronic conditions
10/13/2025
by: Amanda Rubin, CPC, CRC
Chronic conditions are among the most frequently encountered diagnoses in the outpatient setting. Accurately coding these conditions is critical not only for proper reimbursement but also for compliance, quality reporting and patient care continuity.
Denials on most-billed modifier 25 claims are up across the board
10/13/2025
by: Richard Scott
Pay attention to your same-day E/M claims when reporting modifier 25 (Significant, separately identifiable E/M service). Denial rates climbed across the board on the codes most frequently billed with the E/M modifier.
After WISeR, new ASC prior authorization demo signals a growing trend
10/06/2025
by: Roy Edroso
On the heels of the Wasteful and Inappropriate Services Reduction (WISeR) demonstration model for prior authorization comes a new demo targeting ambulatory surgery centers (ASC). Some observers, including physicians and practice consultants, worry that this new development signals a trend toward increased prior authorization in traditional Medicare.
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