Keys to Support Medical Necessity in Dermatology
I recently spoke at high level about denials at the DMA conference, including Medical Necessity—specifically, how to defend claims when a payer alleges services fail to meet the “reasonable and necessary” standard. In FY 2025, DOJ reported record False Claims Act recoveries exceeding $5.7 billion tied to healthcare matters, with enforcement heavily focused on medically unnecessary or substandard care, […]
Important Update: New Medicare Advance Beneficiary Notice (ABN) Now Approved
CMS has announced an update to the Medicare Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131, now approved by the Office of Management and Budget (OMB). The newly revised ABN is effective immediately and valid through March 31, 2029. The ABN helps beneficiaries make informed decisions when services or supplies may not be covered by Medicare. Providers are […]
Superficial Radiation Therapy 2026 CPT Code Overhaul: An Updated Guide for Dermatology Practices
The landscape for billing and coding Superficial Radiation Therapy (SRT) is undergoing a significant shift. With the 2026 CPT code updates, the American Medical Association has completely restructured how these [...] OIG Audit Confirms: Postoperative Visit Reporting (99024) is a Top Compliance Priority
At Compass Healthcare Consulting, we closely monitor regulatory developments to help our clients stay ahead of compliance risks and issues that can impact revenue. A recent report from the U.S. Department of Health and Human Services Office [...] Unmatched Expertise in Healthcare Consulting: Your Partner for Compliance & Growth
In the ever-evolving landscape of healthcare, navigating complex regulations, optimizing revenue integrity, and ensuring bulletproof compliance requires more than just a consultant—it demands a seasoned team with deep, collective expertise. [...] Navigating 2026 Skin Substitute Policy Changes: A Guide for Dermatology Practices
The Centers for Medicare & Medicaid Services (CMS) has implemented significant changes to the payment methodology for skin substitute products beginning in CY 2026 that will significantly reduce the reimbursement [...] The New Language Access Rules: An Overview for Practice Manager
The US Department of Health and Human Services (HHS) has finalized an update to Section 1557 of the Affordable Care Act, with a new effective date of July 5, 2024. Some provisions [...] Medicare Telehealth Flexibilities Restored and Extended Through January 30, 2026
The proposed CR extends Medicare telehealth flexibilities (Sec. 6208), which were previously extended by the Consolidated Appropriations Act of 2023, through January 30, 2026. These flexibilities include the following: Medicare beneficiaries to continue to receive telehealth services at any site, regardless of type or location, including the beneficiary’s home (i.e., lifting geographic restrictions and maintaining an expanded list of […]
Automated Downcoding – How to Fight Back
The planned policies from Aetna and Cigna represented a significant shift from, “if it wasn’t documented it wasn’t done” to “guilty until proven innocent” – with payers automatically denying level four and five office visit codes with no review of medical record documentation. The following table summarizes the core elements of these policies based on […]
CMS Halts Medicare Claims Payments Due to Government Shutdown: Key Steps for Healthcare Providers
The Centers for Medicare & Medicaid Services (CMS) has announced a temporary pause on Medicare claims payments effective October 1, 2025, as a result of the ongoing federal government shutdown. This action is part of standard CMS contingency plans when congressional payment “extenders” lapse without renewal. Understanding the Medicare Claims Payment Delay CMS has instructed all Medicare Administrative Contractors […]
