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06/30/2025
You can take your team through the notes for the 487 new diagnosis codes when you receive your 2026 DecisionHealth ICD-10-CM manual. But remember to check the tabular addenda for codes that you regularly report so you don’t miss additional information that can augment coding through more guidance or alert you to potential pitfalls.
06/30/2025
CMS developed medically unlikely edits (MUE) as a way to limit the number of times a particular service is allowed to be billed by a single provider to a single patient on a given date of service. Medicare began using these unit-of-service edits in 2007 in an effort to reduce payment errors for Medicare Part B claims.
06/30/2025
Selecting a level of medical decision-making (MDM) is confusing and complicated. This article defines key terms and describes a simplified system for selecting a level.
06/30/2025
Practices turned to two of the X-series modifiers in place of modifier 59 (Distinct procedural service) more than 7 million times in 2023 and saw mixed results with denial rates on the top-billed codes.
06/23/2025
Keep HIPAA compliance front-of-mind when a patient asks you to send their records to an employer. In particular, your practice should understand when you do and do not need a patient’s authorization to disclose protected health information (PHI) in response to an employment-related request.
06/23/2025
While all Medicare providers should be interested in the prospective change to physician payments in Congress’ pending budget bill, there are a few other pieces of the bill that would affect them indirectly. Medicaid and Affordable Care Act (ACA) cuts, for example, appear to increase the number of uninsured and threaten at-risk hospitals. Also, the sequestration cut isn’t going up — or going away.
06/23/2025
Make sure you incorporate current CMS coding guidance for three preventive services into your workflow and check for denials that might be candidates for an appeal.
06/23/2025
Question: Our providers have started to perform some services that are 100% patient pay, such as platelet rich plasma injections to treat pain. Do we need a separate policy for documenting services when the record doesn’t need to support a code?
06/23/2025
Upcoding is becoming a more common practice across all outpatient settings, according to a recent Trilliant Health report.
06/23/2025
Analysis of Medicare Part B claims data indicates that when practices bring in a substitute physician, they favor the fee-for-time arrangements over reciprocal billing arrangements. A closer review of the claims data reveals the specialists who are most likely to bring in a substitute when they take time off.

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