Part B News | Ask a Part B News Expert

HIPAA Q&A: Aim for measurable outcomes, risk management

10/26/2026

Grappling with HIPAA compliance is a time-consuming endeavor, and some priorities aren’t attaining the desired outcomes. Health care organizations are spending too much time proving they’re compliant and not enough time improving their security, according to James Winebrenner, CEO of Elisity.

Keep tabs on payer LCD, provider documentation to head off visco denials

10/12/2026

by: Laura Evans, CPC

Question: We were audited recently for 10 claims where the patients received Durolane, specifically, and all 10 claims were denied for lack of medical necessity. A customer service representative told me that the documentation had to provide quantifiable evidence of pain reduction and/or increased range of motion for a repeat injection. I don’t know what would be considered adequate demonstration of medical necessity for an initial injection. Medicare can’t tell me...

Boost your behavioral health encounter documentation

09/21/2026

by: HCPro staff

Question: What are common documentation gaps in behavioral health encounters?

Track scenarios to discern how documentation drives diabetes coding

09/07/2026

by: HCPro staff

Question: How does documentation specificity affect diabetes code assignment?

Monitor modifier 25 red flags: Watch frequency, replication

08/17/2026

by: HCPro staff

Question: What are some red flags associated with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) that might trigger payer audits?

Boost communication to augment E/M medical decision-making

06/15/2026

by: HCPro staff

Question: What are some tips for properly documenting E/M visits as it relates to medical decision-making (MDM), particularly when it comes to improving communication with providers?

Patient right of access: Prepare as OCR’s enforcement campaign continues

05/11/2026

by: Dom Nicastro

Federal regulators continue to signal that delayed patient access to medical records is one of the most visible and enforceable areas of HIPAA compliance.

ICD-10-CM updates: How to code for patients with diabetes in remission

04/27/2026

by: HCPro staff

Question: Can you explain when it is appropriate to use the recently added ICD-10-CM code for diabetes in remission?

Remind providers to document their active participation in incident-to services

04/20/2026

by: Julia Kyles, CPC

Question: An auditor from our Medicare administrative contractor recently informed our practice that to bill services incident-to, the supervising physician must actively participate in the patient’s care, which means seeing the patient every 12 months. Is that what active participation means?

Remind surgeons that NCCI rules for post-op pain management still apply

04/06/2026

by: Julia Kyles, CPC

Question: I work for a group of surgeons that wants to start billing for post-operative pain blocks. For example, a transversus abdominis plane block (64486-64489) for hernia repair or an intercostal block (64420-64421) for post-mastectomy pain. In the past they’ve asked the anesthesiologist to perform the service, but they claim that they can bill Medicare under a new rule designed to reduce the use of prescription opioids to manage post-operative pain. Is that correct?

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