KZA Alerts

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

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 RuleFederal Register

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 We also highlight the risks of continuing to use outdated forms and why this seemingly small change can have significant financial implications for your practice.For direct access to the updated form, CMS resources,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-initiativeCMS ABN Page: cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abnMedicare Learning Network (MLN): cms.gov/training-education/medicare-learning-networkr-mln/resources-trainingContact 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 servicesOngoing coverage for audio-only telehealth visitsRemoval of geographic and originating site restrictionsContinued authorization for RHCs and FQHCs to serve as distant-site telehealth providersExtended flexibility for behavioral health and hospice recertification via telehealthAn extension of the Acute Hospital Care at Home program through 2030Upcoming new CMS telehealth billing modifiers expected in 2027This 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.

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 claimsEnforcement of ICD-10-CM Excludes1 coding rules across outpatient and professional servicesUpdated radiology interpretation documentation standards required for professional component reimbursementThis 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

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 effectHow retroactive coverage applies to claims submitted—or held—after October 1, 2025What specialty practices need to know about resuming telehealth servicesImmediate action steps for billing, coding, scheduling, and revenue cycle teamsWhy this extension represents temporary relief—not a permanent policy solutionThis 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