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Physician associates continue to rise, in price and in prestige

05/19/2025

New findings from the American Association of Physician Associates (AAPA) show that PAs remain a growth industry — not only in number and compensation, but also in independent practice.

Decode the independent interpretation of tests for E/M coding

05/19/2025

by: Julia Kyles, CPC

Make sure your staff know when they can count the independent review of a test toward medical decision-making (MDM). Independent interpretation of a test can lift the level of the “amount and/or complexity of data to be reviewed and analyzed (data)” element of an E/M visit to moderate or extensive, depending on the work performed for an encounter.

Trump tries ‘Most Favored Nation’ drug pricing again, this time with Part D

05/19/2025

by: Roy Edroso

On May 12 the Trump administration announced a revival of the “Most Favored Nation” (MFN) drug pricing executive order (EO) similar to one it unsuccessfully tried to implement in President Trump’s first term. Apart from including Part D drugs and some more aggressive language than last time, administration officials did not immediately say how this attempt would achieve a different result.

Double down on risk analysis with support tools, workflow flexes

05/19/2025

by: Dom Nicastro

A recent enforcement action by the HHS Office for Civil Rights (OCR) highlights the consequences of failing to conduct an adequate risk analysis under the HIPAA Security Rule.

Claims jump 17% for PA established office visits over 5 years

05/19/2025

by: Richard Scott

Physician associate (PA) billing boomed in a recent five-year stretch, as total claims climbed dramatically and the frequently reported E/M office visits (99211-99215) surged to new highs.

Consider 4 advantages of making telehealth a permanent part of your practice

05/12/2025

by: Julia Kyles, CPC

Even though Congress didn’t fully unleash telehealth services, instead extending the long-running telehealth waivers through September, making your telehealth services a permanent offering can improve your practice’s financial health.

OK to promote your practice to outside patients, but watch poaching concerns

05/12/2025

by: Roy Edroso

The recent closure of a major practice in Rhode Island, and the efforts of a separate practice to pick up their patients, raises the question: Is it out of line to actively solicit another provider’s patients?

CMS says physician-owned hospital can move location, and add ER

05/12/2025

by: Roy Edroso

Physician-owned hospitals must conform to strict rules under Medicare, but a recent advisory opinion (AO) from CMS suggests a way they can expand their offerings without losing their status.

Keep tabs on OIG’s Work Plan: A road map for compliance

05/12/2025

by: HCPro staff

Since 1976, the Office of Inspector General (OIG) has served as a compliance watchdog, overlooking all HHS programs and monitoring for instances of fraud, waste and abuse. While health care organizations can wait to investigate potential compliance issues until they receive an audit request or gain access to audit findings, you’re better off taking a proactive approach. One important step is monitoring for additions to the OIG Work Plan.

Critical care codes fall hard from COVID boom, resetting trend curve

05/12/2025

by: Roy Edroso

Medicare utilization of many CPT codes, such as outpatient E/M codes, took a beating in the pandemic years. But use of the critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and add-on code 99292 ( … ; each additional 30 minutes) jumped higher during that period.

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