Lots of new members recently! Would love for you guys to introduce yourself. Thanks!

Medicare’s pandemic-era telehealth flexibilities are rolling back. That means: - If you weren’t eligible for telehealth reimbursement before COVID, chances are you may not be paid now. - Exceptions remain for:✔️ Mental health & substance use treatment✔️ ESRD check-ins✔️ Rural areas 👉 Translation: if you see Medicare patients and rely on telehealth, payment may not be guaranteed moving forward. What you can do right now: 1. Have patients sign an ABN (Advance Beneficiary Notice). 2. Consider collecting a deposit upfront—but have a refund process ready if Medicare does pay. 3. Update your staff with a clear script so patients aren’t surprised by bills. 📄 Here are two resources to help you prepare: - CMS ABN Form (official) - Sample Telehealth Policy This isn’t fun news, but being proactive keeps your revenue safe. 🎙️ We’ll break this down in more detail on our upcoming NatRevMD Podcast—plus catch quick updates on our YouTube Channel @NatRevMD.

1️⃣ Cigna Downcoding Cigna is rolling out a new downcoding policy. Their system may automatically reduce your E/M level (for example, billing a 99215 but being paid for a 99213) if they don’t think your diagnoses support the higher level. While other payers have been doing this, very low volume of these denials seen so far. What do you do? ⚠️ This isn’t about your documentation quality — it’s payer-driven. 👉 Track your Cigna claims closely. 👉 Watch for CARC code C150 (downcoded payment). 👉 Be ready to appeal with documentation. 👉 Consider emailing provider rep saying you want OUT of auto downcoding. 2️⃣ Medicare Telehealth Starting Oct 1, 2025: Non-behavioral telehealth: Geographic + originating site restrictions return. ESRD-related monthly assessments allowed. Behavioral / mental health telehealth: Patients can continue visits from home for: • Mental health disorders • Substance use disorder What do you do? 👉 Collect ABNs when coverage is uncertain. 👉 Commercial payers may not follow Medicare’s lead — stay alert. Bottom line: Don’t let these changes catch you off guard. Protect your revenue by monitoring claims and updating your telehealth workflows. #cigna #Medicare #Telehealth #MedicalBilling #RevenueCycle #PhysicianPractice #NatRevMD

Please make sure you have your contracts and know when it is time to re-negotiate. Typically its 3 years after signature. Some as early as 1 year!

Please introduce yourself and let us know what questions you have related to billing!