Part B News | Part B News

Feds sharpen AI fraud tools; plan ahead, and fight if necessary

07/20/2026

Rumblings from CMS suggest that the agency and its associates plan to make greater use of artificial intelligence (AI) fraud-catching tools in days to come. Experts say you can look at the way AI parses data to prepare for audits that are informed by it.

Incident-to update: More Blue plans tighten policies for reporting, reimbursement

07/20/2026

by: Julia Kyles, CPC

Remind staff that they can’t assume a commercial payer’s incident-to policies will match Medicare’s. The latest examples come from Blue Cross Blue Shield plans in North Carolina and Michigan.

MGMA, AMGA report that provider compensation is up, but barely

07/20/2026

by: Roy Edroso

Two major medical practice organizations, the Medical Group Management Association (MGMA) and the American Medical Group Association (AMGA), recently released survey results on provider compensation data. Both see compensation rising, but slowly and unevenly, and generally agree that it doesn’t track with physician productivity, which by some measures can be said to have decreased.

Conversion factor dips as CMS proposes cuts, floats major coding updates

07/20/2026

by: DecisionHealth staff

Brace for impact: CMS announced a reduction to physician fees for CY 2027 that would, in aggregate, lower payments across the board. The conversion factor (CF), one of CMS’ primary ratesetting mechanisms, would drop between 1% and 2% depending on the professional fee setting.

Practices take modest approach to caregiver training after 2024 debut

07/20/2026

by: Richard Scott

Medical groups took a slow embrace of caregiver training services (CTS) after CMS rolled out three codes eligible for Medicare billing in 2024. But practices still cleared more than half of a million dollars in payments for the codes, hinting at greater potential ahead.

GLP-1 Bridge in effect; prepare with protocol for patient wave

07/13/2026

by: Roy Edroso

The GLP-1 Bridge demonstration program, through which eligible Part D beneficiaries can obtain semaglutide products for $50 a month, began on July 1. Prepare for what could be a large influx of visits and possibly confused requests with a clear understanding of the program parameters and billing alternatives.

Note new billing guidance for RHC, FQHC distant site telehealth services

07/13/2026

by: HCPro staff

CMS released new billing instructions for rural health clinics (RHC) and federally qualified health centers (FQHC) that provide distant site telehealth services.

Component coding and more: Assess your knowledge of angiography coding

07/13/2026

by: HCPro staff

Know which factors, such as type of vessel and catheter placement, come into play when coding for angiographies. That will ensure your code selection is accurate and help you avoid disruptions to your revenue

E/M coding scenario: Suspected MS meets a level 5 established office visit

07/13/2026

by: HCPro staff

Under the current E/M guidelines for level-based services, previously vital components of code level selection — namely, the history and exam components — no longer factor into the level of decision-making. Instead, determining a level of service comes down to one of two components: Medical decision-making (MDM) or time. The following coding scenario provides a closer look at the MDM guidelines that dictate code choice. T

Screenings get healthy use, but watch some denial traps

07/13/2026

by: Roy Edroso

The top 10 preventive screening codes under Medicare have stayed fairly uniform over the past few years, and their overall utilization continues to ride on a post-COVID rise. But some codes get denied more often than providers might expect.

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.