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Pay close attention to medical necessity when a provider schedules a patient for a preoperative visit and you code the E/M visit. Even though a hospital may require preoperative clearance for surgery patients, Medicare controls whether it will pay for the visits. Surgeons may have more leeway than specialists when they perform certain preoperative visits, but they must still support medical necessity to protect their patients from an unexpected bill and the practice from unexpected denials.
On April 2, CMS approved a final average 3.7% increase on the Medicare Advantage base rate for 2025, an adjustment Medicare Advantage organizations (MAO) and the insurers who run them found disappointing. While some advocates have suggested these plans will pull back on benefits, large changes are not expected in the short run.
In this week’s issue, Rebecca Herold, CDPSE, FIP, CISSP, CIPM, CIPP/US, CIPT, CISM, CISA, FLMI, HIPAA security and privacy training expert and CEO of Privacy & Security Brainiacs SaaS services, answers a range of questions about cybersecurity efforts, HIPAA compliance in health apps and much more.
The most recent CMS numbers show Medicare Advantage enrollment continuing to outpace traditional Medicare, and some measures suggest Part C has already beat fee-for-service Medicare to become the majority Medicare insurer.


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