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Submit or resubmit telehealth claims for services during the shutdown

12/08/2025

The Continuing Appropriations and Extensions Act, 2026 (CAE 2026) reactivated the COVID-19 telehealth waivers until Jan. 30, 2026, and delayed face-to-face requirements for mental health services.

Shutdown stopgap solves GPCI, other issues, but questions remain

12/08/2025

by: Roy Edroso

The fate of telehealth claims from the 43-day government shutdown were probably the biggest worry for Medicare providers before the continuing appropriations legislation ended the shutdown on Nov. 12. Other health care issues were also resolved by the bill, at least through Jan. 30. But others were not.

Take time to review your MAC’s requirements for recording E/M time

12/08/2025

by: Julia Kyles, CPC

After a few years of confusion about how providers should document time for level-based E/M services, the consensus can be summarized as “make it make sense,” according to a review of guidance issued by all seven Medicare administrative contractors (MAC).

Use scenarios, physician guidance for COVID-19 immunization update

12/08/2025

by: Julia Kyles, CPC

The COVID-19 vaccine administration code will be revised and a new add-on code implemented effective Jan. 1, 2026. The AMA CPT Editorial Panel made the changes to prepare for pending combination COVID-19 and influenza vaccines, when they are available.

CMS, private payers respond to COVID-19 vaccine administration snafu

12/08/2025

by: Julia Kyles, CPC

CMS will expedite the next National Correct Coding Initiative (NCCI) update to stop denials when a provider reports administration of the COVID-19 vaccine and another vaccine code for the same patient on the same day.

The audit may be over, but your team’s work has just begun

12/08/2025

by: Julia Kyles, CPC

After you’ve been through an audit, don’t put the experience behind you and move on. Whether the audit revealed some areas for improvement or your providers passed the audit with top grades, there are lessons to be learned from an audit that you can use to ensure future success. For example, experts agree that no matter what the outcome, you and your team should take advantage of any education that is offered or available after the audit.

Prior auth requests swelled, but denials didn’t follow

12/08/2025

by: Julia Kyles, CPC

Prior authorization requests for eight types of services performed in the hospital outpatient setting took a great leap forward in fiscal year (FY) 2024. But there’s good news: While requests nearly doubled from FY2023 to FY2024, denials did not keep pace.

Address answers, new codes, permanent expansions in telehealth update

11/24/2025

by: Julia Kyles, CPC

While the fate of popular telehealth waivers created during the COVID-19 public health emergency remains in limbo — due to the recent shutdown-ending legislation that only extended the waivers through Jan. 30, 2026 — Medicare’s original telehealth remains intact, and the agency included five expansions and clarifications in the final 2026 Medicare physician fee schedule.

CMS slaps uniform payment rate on skin substitutes, applies incident-to rules

11/24/2025

by: Laura Evans, CPC

Get ready for a reduction in reimbursement for so-called skin substitutes, the externally applied grafts used to treat non-healing diabetic foot ulcers and venous leg ulcers.

Shared Savings pushes risk, but experts debate the impact

11/24/2025

by: Roy Edroso

Most of the significant changes to the Medicare Shared Savings Program (MSSP) have been confirmed in the final 2026 Medicare physician fee schedule, with a major emphasis on making it easier for new and slow-to-advance entrants to take on risk. However, experts aren’t sure it’ll work.

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