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Latest Insights from Our Experts
We deliver clear, timely insights into complex regulatory changes keeping clients informed and compliant.
2026 Telehealth Policy Update: Medicare Flexibilities Extended
The Consolidated Appropriations Act, 2026 extends major Medicare telehealth flexibilities through December 31, 2027. This ensures continued home-based care, audio-only coverage, and deferred in-person requirements for behavioral health until 2028.
Feb 4, 2026
Guidance for “Incident to” Billing under Center for Medicare & Medicaid services (CMS)
CMS "incident-to" billing requires a physician-established plan, direct on-site supervision, and no new clinical decisions. If a new problem or plan arises, bill under the NPP's NPI (85%).
Jan 29, 2026
Documentation and Compliant Billing Requirements for CPT 96127
Compliance memo for CPT 96127: Bill only for validated, scored, and reviewed tools. Documentation must include tool name, score, interpretation, and clinical action to ensure audit readiness.
Jan 14, 2026
UHC PCP Referral Requirements
Effective Jan. 1, 2026, UHC Medicare Advantage HMO and HMO-POS members require PCP referrals for most specialist services. PCPs must submit referrals prior to visits to avoid claim denials and provider liability.
Jan 7, 2026
KeyLift Interlaminar Decompression Review
As an unlisted procedure, reimbursement will be highly variable and not covered by Medicare in an ASC, subject to prior authorization, and at high risk for denial without extensive supporting documentation.
Dec 3, 2025
New CPT codes for MILD
The MILD procedure will transition to new Category I CPT codes: 62330 (first interspace) and 62331 (additional interspaces) effective starting January 1, 2026. Reimbursement has not yet been published.
Nov 4, 2025
ICD-10-CM Changes
FY 2026 ICD-10-CM updates expand pain and symptom codes, especially R10 abdominal, pelvic, and perineal pain with new laterality-specific options.
Oct 16, 2025
E/M Downcoding Policies – Aetna, Humana and Cigna
Aetna, Humana, and Cigna began automatically downcoding high-level E/M services (99214/99215). Using algorithms instead of manual record reviews, these policies create a payment gap.
Oct 7, 2025
Telehealth Changes Effective October 1, 2025
Medicare telehealth flexibilities expire. Non-behavioral visits require approved originating sites , though behavioral health retains home options.
Sep 22, 2025
Why Accurate Medical Coding Matters More Than Ever
Proper medical coding drives compliance, prevents denials, and protects revenue. Learn why accuracy is critical to a strong, reliable healthcare revenue cycle.
Sep 8, 2025
Top 5 Ways to Reduce Claim Denials
Simple steps every healthcare provider can take to ensure faster reimbursements and fewer revenue losses.
Aug 25, 2025
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