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Survey: Docs leave practices even when satisfied; time for retention nudge?

08/18/2025

Everyone seems to agree that “job satisfaction” is an important factor in retaining employees, including clinical staff at a physician practice. But what if the staff are satisfied with their jobs — yet still more than willing to leave?

Avoid penalties, take a more proactive approach to risk analysis

08/18/2025

by: Dom Nicastro

A recent settlement between the Office of Civil Rights (OCR) and Health Fitness Corporation offers a sharp reminder of the steep consequences of neglecting HIPAA Security Rule compliance, especially the risk analysis requirement that underpins effective protection of electronic protected health information (ePHI).

Few outpatient hospital E/M claims, but they beat the denial spread

08/18/2025

by: Roy Edroso

The small number of outpatient E/M codes (99202-99215) performed in hospital outpatient clinics and claimed with the outpatient place of service (POS) codes saw only modest growth in 2023. But they had better denial rates than you might expect.

Investigate all three RVU amounts for accurate pay predictions

08/11/2025

by: Julia Kyles, CPC

A Part B News subscriber’s question about telemedicine payments, and the release of the proposed 2026 Medicare physician fee schedule, contain lessons that apply to all services: Check the relative value units for services you commonly report every year. And while you’re at it, look at the calculations for new services you plan to perform.

Pushed on all sides, Medicare Advantage plans make pledges on prior authorization

08/11/2025

by: Roy Edroso

The struggle against prior authorization in Medicare Advantage has raged for years, but a new wave of voluntary self-reforms by payers suggests that patient, payer and government pressure may be forcing some reforms.

Could USPSTF cuts be a threat to Medicare preventive payments?

08/11/2025

by: Roy Edroso

The Affordable Care Act authorizes the U.S. Preventive Services Task Force to make recommendations that result in no-cost preventive services coverage for beneficiaries of Medicare and other plans. But conflict between the Task Force and HHS Secretary Robert F. Kennedy Jr. may disrupt that process.

OIG global surgery billing report reminds practices to check their coding compliance

08/11/2025

by: Julia Kyles, CPC

Payments for services during the global surgery period remain a hot-button issue and the data collection program CMS implemented in 2017 is back in the spotlight, thanks to a July 1 report by the HHS Office of Inspector General. The OIG spelled out its conclusions in the July 1 report titled “CMS Should Improve Its Methodology for Collecting Medicare Postoperative Visit Data on Global Surgeries.”

Sudden impact: Proposed payment chart highlights CMS’ pay plans

08/11/2025

by: Julia Kyles, CPC

CMS has big plans for your Part B payments in 2026. For example, it wants to restructure reimbursement to favor services performed in non-facility settings, such as the office, and slash payments for services performed in the facility setting.

Part II: Preview 96 new CPT codes that Medicare will cover in 2026

08/04/2025

by: Julia Kyles, CPC

Give your team an early look at new services that you’ll find in the 2026 CPT manual, and that CMS plans to cover in the coming year. The July 28 issue covered E/M, musculoskeletal and cardiovascular codes, among others. Look below for more additions to the CPT code set.

CMS to add 5 services, delete SDOH assessment from telehealth list

08/04/2025

by: Julia Kyles, CPC

Look for more counseling services on the list of telehealth-approved codes that Medicare covers. However, note that the new telemedicine codes did not make the grade.

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