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Medical groups report modifier 25 (Significant, separately identifiable E/M service) a whole lot, with claims tagged with the modifier returning north of $4 billion in payments annually. Ensure your modifier coding is accurate, and that your documentation backs it up, to keep revenue coming in.
 
Adding to its other pioneering prescription drug programs under Medicare, the Biden administration announced on Wednesday it would issue a request for information (RFI) on a potential “Medicare $2 Drug List Model” that would make some much-used drugs for hypertension, high cholesterol, and other common conditions available to Part D beneficiaries for a couple of bucks.
 
Get ready to dig into more than 400 code changes as part of the 2025 CPT code set. That includes 270 new codes, including dozens of surgical codes, as well as 112 deletions and 38 revisions.
 
You’ll also find numerous guideline changes within the 2025 CPT Manual, with expanded guidance for the new CPT-based virtual check-in service and online digital E/M services. The AMA released the revised CPT code set in September, while the full guidelines are now accessible as the books are available for purchase ahead of the Jan. 1 implementation date.
 
 
Recent Gibbins Advisors analysis finds that “a relatively high percentage (30%) of very large health care bankruptcies (liabilities >$500M) were [private equity]-backed.” This suggests that the large scale of PE acquisitions, and their tendency to “roll up” smaller entities into larger ones, makes their managers likely to opt for bankruptcy as a tool when finances get difficult.
 
 
Medical groups are bracing for a 3% cut to the Part B conversion factor in 2025, as CMS announced in the proposed 2025 Medicare physician fee schedule. The agency also made important announcements about telehealth services, previewed new codes eligible for billing in the new year, and added a slew of behavioral health services.
 
Don't miss out on the latest billing, coding, compliance and revenue cycle updates coming next year. DecisionHealth, the publisher of Part B News, is running a series of live virtual events intended to boost your proficiency and revenue cycle management and put you on track for a successful 2025 billing year.
 

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