KZA Alerts

The Office of Inspector General has added a new Work Plan item examining Medicare payments for Evaluation and Management services performed on the same day as minor surgical procedures when Modifier 25 was not appended. In this KZA Alert, we explain why this review matters, what the OIG is evaluating, and the documentation and coding requirements practices should revisit now to reduce audit risk....

The American Medical Association has adopted a policy opposing the use of the term "provider" when referring to physicians, arguing that clear professional titles are essential for patient understanding, transparency, and trust. In this KZA Alert, we examine the AMA's reasoning, how the policy fits into the broader conversation around physician-led care and scope of practice, and why the language...

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...

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 inf...

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 

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...

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 updat...

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 workfl...

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 t...

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...

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, w...