Roy Edroso

Baltimore, Washington, D.C.

Editor at Decision Health

Editor at Part B News

Blogger at Roy Edroso Breaks It Down

the only guy on Substack who isn't constantly blubbering about cancel culture! also: @edroso.bsky.social

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Articles

Review the latest rules for HIV PrEP, hepatitis vacc...

1 week ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

Make sure you incorporate current CMS coding guidance for three preventive services into your workflow and check for denials that might be candidates for an appeal. You must log in to view the content you requested. Not a subscriber?
Budget bill follow-up: Medicaid cuts to hit hospital...

1 week ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

While all Medicare providers should be interested in the prospective change to physician payments in Congress’ pending budget bill, there are a few other pieces of the bill that would affect them indirectly. Medicaid and Affordable Care Act (ACA) cuts, for example, appear to increase the number of uninsured and threaten at-risk hospitals. Also, the sequestration cut isn’t going up — or going away. You must log in to view the content you requested.
Follow HIPAA rules when you receive employment-relat...

1 week ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

Keep HIPAA compliance front-of-mind when a patient asks you to send their records to an employer. In particular, your practice should understand when you do and do not need a patient’s authorization to disclose protected health information (PHI) in response to an employment-related request. You must log in to view the content you requested. Not a subscriber?
HIPAA Q&A: Take a deep dive into Security Rule p...

1 week ago | pbn.decisionhealth.com | Julia Kyles |Dom Nicastro |Roy Edroso

Question: How would you summarize the key proposed changes to the HIPAA Security Rule, and why are these updates significant for health care organizations? You must log in to view the content you requested. Not a subscriber?
AMA survey: Private practice keeps declining; hospit...

1 week ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso |Dom Nicastro

A major AMA survey finds a continued decline in practices owned by their physicians — though all is not lost for those that wish to maintain their independence. You must log in to view the content you requested. Not a subscriber?
Introduce staff to new ICD-10-CM codes, tabular upda...

2 weeks ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso |Dom Nicastro

Start training your staff on the diagnosis code changes that will go into effect Oct. 1. CMS will adopt the ICD-10-CM additions, revisions and deletions that it previewed in April. You must log in to view the content you requested. Not a subscriber?
Budget bill would peg physician pay to MEI; might me...

3 weeks ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

The budget bill passed on May 22 in the U.S. House of Representatives, now being considered by the Senate, has a proposed change to the physician fee schedule conversion factor (CF) that, while it doesn’t appear to do anything about low reimbursement rates in 2025, promises some relief in 2026 and possibly in years to follow. But experts caution that the gains may not be what they at first appear. You must log in to view the content you requested.
To ease doctor-departing woes, write careful terms i...

3 weeks ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

If you’re worried that one of your employed physicians will want to leave before their contract expires, be aware that the best time to handle that problem is when they first sign on. Also, remember that “I quit” isn’t always the end. You must log in to view the content you requested. Not a subscriber?
Consult the details for MDM discussions for accurate...

3 weeks ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

Question: When our doctors requests a consult from another doctor, how can we tell whether our physician can count the conversation toward “discussion of management or test interpretation with external physician or other qualified health care professional or appropriate source (not separately reported)” in the data review column for medical decision-making (MDM)?
Brace for tariff impact on lab equipment, syringes, ...

3 weeks ago | pbn.decisionhealth.com | Julia Kyles |Roy Edroso

Heads up: While President Trump continues to alter the tariffs he announced in February, it’s likely that some of your equipment prices will be affected, and you should prepare for cost fluctuations. You must log in to view the content you requested. Not a subscriber?