KZA Alerts Transistor (https://transistor.fm) https://feeds.transistor.fm/kza-alerts The KZA Alerts Podcast delivers timely, audio versions of the official alerts published on KZANOW.com. Each episode provides clear, concise updates on critical developments, helping listeners stay informed quickly and reliably - wherever they may be. © 2025 Karen Zupko and Associates, Inc. 6a08749e-c404-524c-ac0a-073b735c05fe yes Olivia Wolf en Thu, 28 May 2026 17:21:11 -0600 Thu, 28 May 2026 17:22:20 -0600 https://kzanow.com/ https://img.transistorcdn.com/MKIaqByy3yoseTrVlQ639pKXLG_7OPYhT0nr_S5FAtA/rs:fill:0:0:1/w:1400/h:1400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS81OWM3/ZmQ5YjJkYWVmZjg0/ZWIzNTMyMTUzNTAy/YmQ1MS5wbmc.jpg KZA Alerts https://kzanow.com/ episodic KZA Kast The KZA Alerts Podcast delivers timely, audio versions of the official alerts published on KZANOW.com. Each episode provides clear, concise updates on critical developments, helping listeners stay informed quickly and reliably - wherever they may be. The KZA Alerts Podcast delivers timely, audio versions of the official alerts published on KZANOW.com. KZA podcast@kzanow.com No No KZA Alert: OIG Targets Modifier 25 - What Dermatology Needs To Know 9 9 KZA Alert: OIG Targets Modifier 25 - What Dermatology Needs To Know full 49bbb485-5058-477a-a8f5-65266c504c9e https://share.transistor.fm/s/da27557c A new Office of Inspector General (OIG) report is shining a spotlight on the use of Modifier 25 in dermatology, and the findings have implications far beyond a single specialty. In this KZA Alert, we review the OIG’s concerns regarding documentation, E/M leveling, and improper use of Modifier 25, including an estimated $62.9 million in Medicare overpayments tied to same-day E/M services and minor procedures.

We discuss when Modifier 25 is appropriate, the most common compliance pitfalls identified by the OIG, and practical steps providers and coding teams can take to reduce audit risk. Whether you're in dermatology, orthopedics, ENT, general surgery, or another procedural specialty, this episode serves as an important reminder that Modifier 25 should be supported by clear documentation, medical necessity, and a truly distinct evaluation service.

MLN Connects Newsletter for May 28, 2026

]]> A new Office of Inspector General (OIG) report is shining a spotlight on the use of Modifier 25 in dermatology, and the findings have implications far beyond a single specialty. In this KZA Alert, we review the OIG’s concerns regarding documentation, E/M leveling, and improper use of Modifier 25, including an estimated $62.9 million in Medicare overpayments tied to same-day E/M services and minor procedures.

We discuss when Modifier 25 is appropriate, the most common compliance pitfalls identified by the OIG, and practical steps providers and coding teams can take to reduce audit risk. Whether you're in dermatology, orthopedics, ENT, general surgery, or another procedural specialty, this episode serves as an important reminder that Modifier 25 should be supported by clear documentation, medical necessity, and a truly distinct evaluation service.

MLN Connects Newsletter for May 28, 2026

]]> Thu, 28 May 2026 17:21:09 -0600 KZA Kast KZA Kast 298 A new Office of Inspector General (OIG) report is shining a spotlight on the use of Modifier 25 in dermatology, and the findings have implications far beyond a single specialty. In this KZA Alert, we review the OIG’s concerns regarding documentation, E/M leveling, and improper use of Modifier 25, including an estimated $62.9 million in Medicare overpayments tied to same-day E/M services and minor procedures.

We discuss when Modifier 25 is appropriate, the most common compliance pitfalls identified by the OIG, and practical steps providers and coding teams can take to reduce audit risk. Whether you're in dermatology, orthopedics, ENT, general surgery, or another procedural specialty, this episode serves as an important reminder that Modifier 25 should be supported by clear documentation, medical necessity, and a truly distinct evaluation service.

MLN Connects Newsletter for May 28, 2026

]]> KZA, Medical Coding, Practice Management, Audit, Modifier 25, OIG Audits No Olivia Wolf KZA Alert: CMS 2.5% Physician Fee Schedule Efficiency Adjustment 8 8 KZA Alert: CMS 2.5% Physician Fee Schedule Efficiency Adjustment full 12a81155-3429-4ac2-ac00-ab4ad627ec6a https://share.transistor.fm/s/d11df639 CMS has implemented a 2.5% “efficiency adjustment” to most non-time-based CPT and HCPCS codes under the CY 2026 Physician Fee Schedule—and for many procedural and surgical specialties, the impact may be greater than it initially appears. In this KZA Alert, we break down what the adjustment means, why surgeons and procedural practices may be disproportionately affected, and how the change could influence Medicare and commercial payer reimbursement moving forward.

This rapid-response update explores the financial and operational implications of the new rule, including pressure on procedural RVUs, rising fixed costs, site-of-service strategy, and the growing reliance on commercial payer cross-subsidization. We also discuss practical action steps practices should take now to evaluate payer contracts, assess reimbursement risk, and prepare for the long-term effects of continued Medicare payment erosion.

Resources:

]]> CMS has implemented a 2.5% “efficiency adjustment” to most non-time-based CPT and HCPCS codes under the CY 2026 Physician Fee Schedule—and for many procedural and surgical specialties, the impact may be greater than it initially appears. In this KZA Alert, we break down what the adjustment means, why surgeons and procedural practices may be disproportionately affected, and how the change could influence Medicare and commercial payer reimbursement moving forward.

This rapid-response update explores the financial and operational implications of the new rule, including pressure on procedural RVUs, rising fixed costs, site-of-service strategy, and the growing reliance on commercial payer cross-subsidization. We also discuss practical action steps practices should take now to evaluate payer contracts, assess reimbursement risk, and prepare for the long-term effects of continued Medicare payment erosion.

Resources:

]]> Wed, 27 May 2026 02:33:40 -0600 KZA Kast KZA Kast 283 CMS has implemented a 2.5% “efficiency adjustment” to most non-time-based CPT and HCPCS codes under the CY 2026 Physician Fee Schedule—and for many procedural and surgical specialties, the impact may be greater than it initially appears. In this KZA Alert, we break down what the adjustment means, why surgeons and procedural practices may be disproportionately affected, and how the change could influence Medicare and commercial payer reimbursement moving forward.

This rapid-response update explores the financial and operational implications of the new rule, including pressure on procedural RVUs, rising fixed costs, site-of-service strategy, and the growing reliance on commercial payer cross-subsidization. We also discuss practical action steps practices should take now to evaluate payer contracts, assess reimbursement risk, and prepare for the long-term effects of continued Medicare payment erosion.

Resources:

]]> KZA, Medical Coding, Practice Management, Audit, Medicare Physician Fee Schedule, Revenue Strategy, Healthcare finance No Olivia Wolf KZA Alert: Reducing AI Coding Audit Risks 7 7 KZA Alert: Reducing AI Coding Audit Risks full 6f8c0319-989f-4cd3-98ba-beca98674b81 https://share.transistor.fm/s/2987ec5c AI is rapidly transforming medical coding and documentation, but without proper oversight, it can introduce serious compliance and revenue risks. In this KZA Alert, we break down the most common pitfalls of unaudited AI-assisted coding and what practices should be doing now to safeguard accuracy, reduce denials, and protect against audit exposure 

]]> AI is rapidly transforming medical coding and documentation, but without proper oversight, it can introduce serious compliance and revenue risks. In this KZA Alert, we break down the most common pitfalls of unaudited AI-assisted coding and what practices should be doing now to safeguard accuracy, reduce denials, and protect against audit exposure 

]]> Tue, 14 Apr 2026 13:57:23 -0600 KZA Kast KZA Kast 330 AI is rapidly transforming medical coding and documentation, but without proper oversight, it can introduce serious compliance and revenue risks. In this KZA Alert, we break down the most common pitfalls of unaudited AI-assisted coding and what practices should be doing now to safeguard accuracy, reduce denials, and protect against audit exposure 

]]> AI, KZA, Medical Coding, Practice Management, Audit No Olivia Wolf KZA Alert: Modifier 25 Reduction - BCBS Michigan and FEP Policy Update 6 6 KZA Alert: Modifier 25 Reduction - BCBS Michigan and FEP Policy Update full c066a6ab-8665-4489-b0f3-cc17568b51d5 https://share.transistor.fm/s/44b42128 Blue Cross Blue Shield of Michigan and Blue Care Network are implementing a major reimbursement change for E/M services billed with Modifier 25; these changes also apply to the Federal Employee Program. In this KZA Alert, we break down what’s changing, who’s affected, and what practices need to do now to prepare for the May 1, 2026 effective date. Links to the full policy and source materials are available below:
Full Modifier 25 Reimbursement Policy

]]> Blue Cross Blue Shield of Michigan and Blue Care Network are implementing a major reimbursement change for E/M services billed with Modifier 25; these changes also apply to the Federal Employee Program. In this KZA Alert, we break down what’s changing, who’s affected, and what practices need to do now to prepare for the May 1, 2026 effective date. Links to the full policy and source materials are available below:
Full Modifier 25 Reimbursement Policy

]]> Thu, 02 Apr 2026 14:34:46 -0600 KZA Kast KZA Kast 246 Blue Cross Blue Shield of Michigan and Blue Care Network are implementing a major reimbursement change for E/M services billed with Modifier 25; these changes also apply to the Federal Employee Program. In this KZA Alert, we break down what’s changing, who’s affected, and what practices need to do now to prepare for the May 1, 2026 effective date. Links to the full policy and source materials are available below:
Full Modifier 25 Reimbursement Policy

]]> Healthcare, Medical Practice Management, Revenue Cycle, Medical Coding, Healthcare Compliance, CMS, HIPAA, Regulatory Updates, Healthcare Policy, Medical Billing, Coding Professionals, Practice Managers, Healthcare Executives, KZA Alerts, Healthcare Updates, Modifier 25, Reimbursement No Olivia Wolf KZA Alert: New HIPAA Standards for Claims Attachments & E-Signatures 5 5 KZA Alert: New HIPAA Standards for Claims Attachments & E-Signatures full 55507a95-c76f-4a14-99c4-841ac31b9b1e https://share.transistor.fm/s/691cedb8 HHS has finalized a major administrative simplification rule establishing the first national HIPAA standards for electronic claims attachments and electronic signatures. In this KZA Alert, we break down what this change means for healthcare organizations, including new transaction requirements, updated security standards, and the transition away from manual, paper-based processes.

This quick update highlights key dates, operational impacts, and early action steps to help practices prepare for compliance ahead of the 2028 deadline. Links to source materials are below:

CMS.gov Final Rule
Federal Register

]]> HHS has finalized a major administrative simplification rule establishing the first national HIPAA standards for electronic claims attachments and electronic signatures. In this KZA Alert, we break down what this change means for healthcare organizations, including new transaction requirements, updated security standards, and the transition away from manual, paper-based processes.

This quick update highlights key dates, operational impacts, and early action steps to help practices prepare for compliance ahead of the 2028 deadline. Links to source materials are below:

CMS.gov Final Rule
Federal Register

]]> Thu, 26 Mar 2026 14:41:41 -0600 KZA Kast KZA Kast 264 HHS has finalized a major administrative simplification rule establishing the first national HIPAA standards for electronic claims attachments and electronic signatures. In this KZA Alert, we break down what this change means for healthcare organizations, including new transaction requirements, updated security standards, and the transition away from manual, paper-based processes.

This quick update highlights key dates, operational impacts, and early action steps to help practices prepare for compliance ahead of the 2028 deadline. Links to source materials are below:

CMS.gov Final Rule
Federal Register

]]> Healthcare, Medical Practice Management, Revenue Cycle, Medical Coding, Healthcare Compliance, CMS, HIPAA, Regulatory Updates, Healthcare Policy, Medical Billing, Coding Professionals, Practice Managers, Healthcare Executives, KZA Alerts, Healthcare Updates, Claims Attachments, Electronic Signatures No Olivia Wolf KZA Alert: 2026 ABN Changes 4 4 KZA Alert: 2026 ABN Changes full f5d9b67e-cf7e-430b-9b3b-c37614299034 https://share.transistor.fm/s/ad8a7ba9 CMS has released an updated version of the Advance Beneficiary Notice of Noncoverage, and practices have a limited window to comply. In this KZA Alert, we break down what’s changed in the revised Form CMS-R-131, who is required to use it, and what steps your team should take now to avoid compliance issues and lost reimbursement.

This update focuses on practical implementation, from updating workflows and systems to ensuring staff are aligned before the May 12, 2026 deadline. We also highlight the risks of continuing to use outdated forms and why this seemingly small change can have significant financial implications for your practice.

For direct access to the updated form, CMS resources, and additional guidance, please see the links provided below:
CMS BNI Webpage: cms.gov/medicare/forms-notices/beneficiary-notices-initiative
CMS ABN Page: cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn
Medicare Learning Network (MLN): cms.gov/training-education/medicare-learning-networkr-mln/resources-training
Contact your Medicare Administrative Contractor (MAC) for jurisdiction-specific guidance.

]]> CMS has released an updated version of the Advance Beneficiary Notice of Noncoverage, and practices have a limited window to comply. In this KZA Alert, we break down what’s changed in the revised Form CMS-R-131, who is required to use it, and what steps your team should take now to avoid compliance issues and lost reimbursement.

This update focuses on practical implementation, from updating workflows and systems to ensuring staff are aligned before the May 12, 2026 deadline. We also highlight the risks of continuing to use outdated forms and why this seemingly small change can have significant financial implications for your practice.

For direct access to the updated form, CMS resources, and additional guidance, please see the links provided below:
CMS BNI Webpage: cms.gov/medicare/forms-notices/beneficiary-notices-initiative
CMS ABN Page: cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn
Medicare Learning Network (MLN): cms.gov/training-education/medicare-learning-networkr-mln/resources-training
Contact your Medicare Administrative Contractor (MAC) for jurisdiction-specific guidance.

]]> Tue, 17 Mar 2026 19:28:37 -0600 KZA Kast KZA Kast 173 CMS has released an updated version of the Advance Beneficiary Notice of Noncoverage, and practices have a limited window to comply. In this KZA Alert, we break down what’s changed in the revised Form CMS-R-131, who is required to use it, and what steps your team should take now to avoid compliance issues and lost reimbursement.

This update focuses on practical implementation, from updating workflows and systems to ensuring staff are aligned before the May 12, 2026 deadline. We also highlight the risks of continuing to use outdated forms and why this seemingly small change can have significant financial implications for your practice.

For direct access to the updated form, CMS resources, and additional guidance, please see the links provided below:
CMS BNI Webpage: cms.gov/medicare/forms-notices/beneficiary-notices-initiative
CMS ABN Page: cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn
Medicare Learning Network (MLN): cms.gov/training-education/medicare-learning-networkr-mln/resources-training
Contact your Medicare Administrative Contractor (MAC) for jurisdiction-specific guidance.

]]> No Olivia Wolf KZA Alert: Consolidated Appropriations Act of 2026 & Extended Telehealth Flexibilities 3 3 KZA Alert: Consolidated Appropriations Act of 2026 & Extended Telehealth Flexibilities full 01135a3c-6cb9-47fe-bfa4-be0519820f31 https://share.transistor.fm/s/c51bd28f Congress has passed, and the President has signed, the Consolidated Appropriations Act of 2026 (H.R. 7148), delivering a major win for Medicare telehealth. The legislation extends pandemic-era Medicare telehealth flexibilities through December 31, 2027, providing much-needed stability for practices and patients alike.

In this KZA Alert, we break down what the extension includes:

  • Continued access to home-based Medicare telehealth services
  • Ongoing coverage for audio-only telehealth visits
  • Removal of geographic and originating site restrictions
  • Continued authorization for RHCs and FQHCs to serve as distant-site telehealth providers
  • Extended flexibility for behavioral health and hospice recertification via telehealth
  • An extension of the Acute Hospital Care at Home program through 2030
  • Upcoming new CMS telehealth billing modifiers expected in 2027

This fast, focused update is designed to help practice leaders, coders, billers, and compliance teams understand what’s changed, how long these policies will remain in effect, and what to watch next as Medicare telehealth policy continues to evolve.

]]> Congress has passed, and the President has signed, the Consolidated Appropriations Act of 2026 (H.R. 7148), delivering a major win for Medicare telehealth. The legislation extends pandemic-era Medicare telehealth flexibilities through December 31, 2027, providing much-needed stability for practices and patients alike.

In this KZA Alert, we break down what the extension includes:

  • Continued access to home-based Medicare telehealth services
  • Ongoing coverage for audio-only telehealth visits
  • Removal of geographic and originating site restrictions
  • Continued authorization for RHCs and FQHCs to serve as distant-site telehealth providers
  • Extended flexibility for behavioral health and hospice recertification via telehealth
  • An extension of the Acute Hospital Care at Home program through 2030
  • Upcoming new CMS telehealth billing modifiers expected in 2027

This fast, focused update is designed to help practice leaders, coders, billers, and compliance teams understand what’s changed, how long these policies will remain in effect, and what to watch next as Medicare telehealth policy continues to evolve.

]]> Wed, 04 Feb 2026 18:24:52 -0600 KZA Kast KZA Kast 297 Congress has passed, and the President has signed, the Consolidated Appropriations Act of 2026 (H.R. 7148), delivering a major win for Medicare telehealth. The legislation extends pandemic-era Medicare telehealth flexibilities through December 31, 2027, providing much-needed stability for practices and patients alike.

In this KZA Alert, we break down what the extension includes:

  • Continued access to home-based Medicare telehealth services
  • Ongoing coverage for audio-only telehealth visits
  • Removal of geographic and originating site restrictions
  • Continued authorization for RHCs and FQHCs to serve as distant-site telehealth providers
  • Extended flexibility for behavioral health and hospice recertification via telehealth
  • An extension of the Acute Hospital Care at Home program through 2030
  • Upcoming new CMS telehealth billing modifiers expected in 2027

This fast, focused update is designed to help practice leaders, coders, billers, and compliance teams understand what’s changed, how long these policies will remain in effect, and what to watch next as Medicare telehealth policy continues to evolve.

]]> KZA, Telehealth, Medical Coding, Auditing, Practice Management No Olivia Wolf KZA Alert: 2026 UnitedHealthcare Policy Changes 2 2 KZA Alert: 2026 UnitedHealthcare Policy Changes full dd9a242e-31c8-41ed-92c8-6e08d39d82c9 https://share.transistor.fm/s/f2c5e521 UnitedHealthcare has announced three major policy changes taking effect in early 2026 that will directly impact claim submission, documentation, and reimbursement for medical practices.

In this KZA Alert, we break down:

  • New mandatory anatomical modifier requirements for surgical and radiology claims
  • Enforcement of ICD-10-CM Excludes1 coding rules across outpatient and professional services
  • Updated radiology interpretation documentation standards required for professional component reimbursement

This rapid-response update is designed to help practice leaders, coders, billers, and compliance teams understand what’s changing, when it takes effect, and what actions to take now to avoid denials and payment delays.

Links to source documentation (including UnitedHealthcare policy updates, the 2026 ICD-10-CM coding guidelines, and CPT references) are available in the corresponding web version of this alert.

KZA Web Alert: https://www.kzanow.com/alerts/united-healthcare-policy-changes

]]> UnitedHealthcare has announced three major policy changes taking effect in early 2026 that will directly impact claim submission, documentation, and reimbursement for medical practices.

In this KZA Alert, we break down:

  • New mandatory anatomical modifier requirements for surgical and radiology claims
  • Enforcement of ICD-10-CM Excludes1 coding rules across outpatient and professional services
  • Updated radiology interpretation documentation standards required for professional component reimbursement

This rapid-response update is designed to help practice leaders, coders, billers, and compliance teams understand what’s changing, when it takes effect, and what actions to take now to avoid denials and payment delays.

Links to source documentation (including UnitedHealthcare policy updates, the 2026 ICD-10-CM coding guidelines, and CPT references) are available in the corresponding web version of this alert.

KZA Web Alert: https://www.kzanow.com/alerts/united-healthcare-policy-changes

]]> Mon, 05 Jan 2026 22:00:00 -0600 KZA Kast KZA Kast 280 UnitedHealthcare has announced three major policy changes taking effect in early 2026 that will directly impact claim submission, documentation, and reimbursement for medical practices.

In this KZA Alert, we break down:

  • New mandatory anatomical modifier requirements for surgical and radiology claims
  • Enforcement of ICD-10-CM Excludes1 coding rules across outpatient and professional services
  • Updated radiology interpretation documentation standards required for professional component reimbursement

This rapid-response update is designed to help practice leaders, coders, billers, and compliance teams understand what’s changing, when it takes effect, and what actions to take now to avoid denials and payment delays.

Links to source documentation (including UnitedHealthcare policy updates, the 2026 ICD-10-CM coding guidelines, and CPT references) are available in the corresponding web version of this alert.

KZA Web Alert: https://www.kzanow.com/alerts/united-healthcare-policy-changes

]]> KZA, United Healthcare, Medical Coding, Auditing, Practice Management No Olivia Wolf KZA Alert: Government Shutdown Ends; Medicare Telehealth Flexibilities Restored 1 1 KZA Alert: Government Shutdown Ends; Medicare Telehealth Flexibilities Restored full 16fc7606-058f-43c2-8e1f-00f9451be7d9 https://share.transistor.fm/s/e7dd9a7d On November 13th, 2025, the 43-day federal government shutdown officially ended, and Congress has passed a continuing resolution funding the government through January 30, 2026. For medical practices, this brings a critical update: Medicare telehealth flexibilities have been restored, extended, and made retroactively applicable to services delivered during the shutdown period.

In this KZA Alert, we break down what the continuing resolution means for Medicare providers, including:

  • Which pandemic-era telehealth flexibilities are back in effect
  • How retroactive coverage applies to claims submitted—or held—after October 1, 2025
  • What specialty practices need to know about resuming telehealth services
  • Immediate action steps for billing, coding, scheduling, and revenue cycle teams
  • Why this extension represents temporary relief—not a permanent policy solution

This fast, focused update is designed to help practice leaders, managers, coders, and billers understand what changed, what actions to take now, and how to prepare for the next potential telehealth policy cliff in early 2026.

KZA Web Alert and links to sources: https://www.kzanow.com/alerts/telehealth-extended

]]> On November 13th, 2025, the 43-day federal government shutdown officially ended, and Congress has passed a continuing resolution funding the government through January 30, 2026. For medical practices, this brings a critical update: Medicare telehealth flexibilities have been restored, extended, and made retroactively applicable to services delivered during the shutdown period.

In this KZA Alert, we break down what the continuing resolution means for Medicare providers, including:

  • Which pandemic-era telehealth flexibilities are back in effect
  • How retroactive coverage applies to claims submitted—or held—after October 1, 2025
  • What specialty practices need to know about resuming telehealth services
  • Immediate action steps for billing, coding, scheduling, and revenue cycle teams
  • Why this extension represents temporary relief—not a permanent policy solution

This fast, focused update is designed to help practice leaders, managers, coders, and billers understand what changed, what actions to take now, and how to prepare for the next potential telehealth policy cliff in early 2026.

KZA Web Alert and links to sources: https://www.kzanow.com/alerts/telehealth-extended

]]> Thu, 13 Nov 2025 17:19:00 -0600 KZA Kast KZA Kast 322 On November 13th, 2025, the 43-day federal government shutdown officially ended, and Congress has passed a continuing resolution funding the government through January 30, 2026. For medical practices, this brings a critical update: Medicare telehealth flexibilities have been restored, extended, and made retroactively applicable to services delivered during the shutdown period.

In this KZA Alert, we break down what the continuing resolution means for Medicare providers, including:

  • Which pandemic-era telehealth flexibilities are back in effect
  • How retroactive coverage applies to claims submitted—or held—after October 1, 2025
  • What specialty practices need to know about resuming telehealth services
  • Immediate action steps for billing, coding, scheduling, and revenue cycle teams
  • Why this extension represents temporary relief—not a permanent policy solution

This fast, focused update is designed to help practice leaders, managers, coders, and billers understand what changed, what actions to take now, and how to prepare for the next potential telehealth policy cliff in early 2026.

KZA Web Alert and links to sources: https://www.kzanow.com/alerts/telehealth-extended

]]> KZA, Telehealth, Government Shutdown, Medical Coding, Auditing, Practice Management No Olivia Wolf