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Review the limits of Medicare’s telehealth exceptions
10/06/2025
by: Julia Kyles, CPC
Question: I know we can have audio-only telehealth visits for patients who are being treated for behavioral and mental health conditions after the telehealth waivers expire. Also, Medicare plans to permanently change direct supervision rules to allow doctors to be “immediately available” through a virtual connection. Does that mean a physician, such as a psychiatrist, could meet the “immediately available” requirement for a mental health or substance abuse encounter, if they’re available by phone?
Docs can use signature stamps if ‘disabled,’ and can prove it
10/06/2025
by: Roy Edroso
Question: I just saw a Medicare Learning Network (MLN) fact sheet that says while CMS doesn’t usually accept stamped signatures on medical documents to indicate the providers has written or reviewed them, “according to the Rehabilitation Act of 1973, we allow a rubber stamp for a signature if the author has a physical disability and provides proof of their inability to sign due to their disability.” Can my provider with arthritis start using a stamp now?
Run data, prepare staff for expanded RADV audits in MA space
10/06/2025
by: Dom Nicastro
As CMS accelerates audits across all Medicare Advantage (MA) contracts for payment years (PY) 2018-2024, your practice must prepare for record demands, coder shortages and complex compliance challenges.
After big change in hospital E/M reporting, use held steady
10/06/2025
by: Roy Edroso
Despite significant changes in standards that came in 2023 for hospital inpatient and observation E/M codes, 2024 was a year of stasis for service utilization — and denials.
Final NCCI update of 2025 includes PTP edits for new codes
09/29/2025
by: Julia Kyles, CPC
Take note of the new coding edits that will go into effect for your Medicare claims Oct. 1, the same day you’ll flip the switch on the FY2026 ICD-10-CM update. You’ll find 1,821 new bundling edits, including those that feature codes that went into effect this year, in the final National Correct Coding Initiative (NCCI) update of the year.
Without congressional action, the end is nigh for telehealth expansions
09/29/2025
by: Julia Kyles, CPC
After five years, most — but not all — of Medicare’s telehealth expansions are scheduled to end at midnight, Oct. 1. Even though one quarter of eligible Medicare patients continue to take advantage of the broader telehealth benefit, it seems unlikely that Congress will pass another last-minute extension or a permanent upgrade to Medicare telehealth law to keep the popular policies in place.
Looming ACA cuts may push patients out of coverage, strain revenue
09/29/2025
by: Roy Edroso
Barring last-minute congressional intervention, the 2026 budget bill will cause a steep rise in Affordable Care Act (ACA) plan premiums. Practices with a lot of those beneficiaries as patients should plan for reduced visits and revenues.
Dissect CPT coding for mental health services, get team buy-in
09/29/2025
by: HCPro staff
Medicare coverage of mental health services has expanded significantly in recent years. Along with authorizing payment for additional services and telehealth options, CMS has established several new provider types.
Top of the class: An add-on code outpaced services introduced in 2024
09/29/2025
by: Julia Kyles, CPC
The top new service of 2024 was an E/M add-on code that paid approximately $23 when it was introduced. Analysis of the latest available Medicare Part B data shows that pelvic examination code 99459 topped the list of CPT service codes that went into effect Jan. 1, 2024. The code also ranked in the top five for submitted charges.
Preventive measures, appropriate responses reduce litigation risks
09/22/2025
by: Julia Kyles, CPC
You’ve educated your staff on how to recognize the warning signs that a patient is litigious. You’ve emphasized that they should communicate their concerns to a supervisor or practice owner. Your next step is to give your team more guidance on what to do when they believe a patient is likely to sue the practice, has threatened to sue, or is currently suing the practice.
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