Topics & Specialty Resources

In February 2024, HHS published a final rule modifying the Part 2 regulations to implement section 3221 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to increase coordination among providers treating patients for SUDs, strengthen confidentiality protections through civil enforcement, align certain Part 2 requirements with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules, and enhance integration of behavioral health information with other medical records to improve patient health outcomes. The final rule provides the public with the ability to file complaints alleging violations of the Part 2 confidentiality provisions, requires Part 2 programs to provide notification of breaches of Part 2 records, and implements in regulation HHS’s civil enforcement authority, including the potential for civil money penalties for violations of Part 2.

Federal contractors – Recovery Audit Contractors (RACs) and Unified Program Integrity Contractors (UPICs) – have increasingly targeted wound care claims, particularly involving expensive skin substitutes billed under Medicare Part B. In 2023 alone, over $1.6 billion was spent on these products, prompting heightened audit activity from Qlarant, Novitas, and others. This...

Ostomy Supplies: Prevent Claim Denials - Chronic Care Management Services — Revised

Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation...

Today, in utilization news, there is a warning to any surgeons who may be reading this – or anyone who works with surgeons. You may see new efforts by the Centers for Medicare & Medicaid Services (CMS) to lower your fees in coming years. We have all heard about...

Commodes, Bed Pans & Urinals: Prevent Claim Denials Claims, Pricers & Codes Integrated Outpatient Code Editor Version 26.2 - Medical Education: Don’t Submit Claims for Programs of All-Inclusive Care for the Elderly - MLN Matters® Articles DMEPOS Fee Schedule: July 2025 Quarterly Update Publications...

CMS Screening, Brief Intervention & Referral to Treatment (SBIRT) Services — Revised; CMS Notifies Individuals Potentially Impacted by Data Incident; CMS Launches New Model to Target Wasteful, Inappropriate Services in Original Medicare

Mechanical Ventilation: Bill Correctly for Inpatient Claims - SNF Services: Prevent Claim Denials MLN Matters® Articles - Ambulatory Surgical Center...

Considering the increase in measles cases in the United States and globally, it is a great time to review how we code for this condition. According to Centers for Disease Control and Prevention (CDC) data, updated on May 30, so far this year we have had 1,088 domestic measles...

Here's a clear and thorough guide for medical coding and billing for Haemophilus influenzae (H. influenzae) — not to be confused with the flu (influenza virus). This bacterium can cause serious invasive diseases like meningitis, epiglottitis, pneumonia, and sepsis. Common ICD-10 Diagnosis Codes: - A41.3...