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 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.
Whether you're a provider, coder, biller, or practice leader, this episode offers practical reminders on appropriate Modifier 25 use, common compliance pitfalls, and proactive audit strategies to help ensure your same-day E/M claims are accurate, defensible, and supported by the medical record.
17 Jun 2026
KZA Alert: AMA Position - Physicians are not Providers
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 healthcare organizations use may have implications for patient safety and informed decision-making.
Whether you're a physician, practice administrator, or healthcare leader, this episode explores the growing debate over professional titles and what it could mean for healthcare communications moving forward.
28 May 2026
KZA Alert: OIG Targets Modifier 25 - What Dermatology Needs To Know
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 (https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-may-28-2026#_Toc230696138)
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:
CY 2026 PFS Final Rule (https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other)
CMS Modernizes Payment Accuracy and Significantly Cuts Spending Waste (https://www.cms.gov/newsroom/press-releases/cms-modernizes-payment-accuracy-significantly-cuts-spending-waste)
AMA Comments on 2026 Medicare Fee Schedule (https://www.ama-assn.org/press-center/ama-press-releases/ama-comments-2026-medicare-fee-schedule)
14 Apr 2026
KZA Alert: Reducing AI Coding Audit Risks
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 available below:
Full Modifier 25 Reimbursement Policy (https://providerinfo.bcbsm.com/documents/alerts/2026/202602/alert-20260226-clarification-policy-update-em-codes-modifier-25.pdf)
26 Mar 2026
KZA Alert: New HIPAA Standards for Claims Attachments & E-Signatures
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 (https://www.cms.gov/newsroom/fact-sheets/administrative-simplification-adoption-standards-health-care-claims-attachments-transactions)
Federal Register (https://www.federalregister.gov/documents/2026/03/24/2026-05676/administrative-simplification-adoption-of-standards-for-health-care-claims-attachments-transactions)
18 Mar 2026
KZA Alert: 2026 ABN Changes
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 (https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative)
CMS ABN Page: cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn (https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn)
Medicare Learning Network (MLN): cms.gov/training-education/medicare-learning-networkr-mln/resources-training (https://www.cms.gov/training-education/medicare-learning-networkr-mln/resources-training)
Contact your Medicare Administrative Contractor (MAC) for jurisdiction-specific guidance.
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.
6 Jan 2026
KZA Alert: 2026 UnitedHealthcare 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 (https://www.kzanow.com/alerts/united-healthcare-policy-changes)
13 Nov 2025
KZA Alert: Government Shutdown Ends; Medicare Telehealth Flexibilities Restored
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 (https://www.kzanow.com/alerts/telehealth-extended)
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