​Denials in oncology infusion billing aren’t minor—it’s lost revenue and compliance risk combined. Our latest session brought together coding and revenue cycle experts to explore denial trends, root causes, and smart strategies in medical oncology infusion practices.

In the world of orthopedics, revenue leakage isn’t just a risk—it’s a reality. And that’s why we brought together Mary Surr and Ashley Carson to lead an insightful, strategy-packed session examining the most common (and costly) pain points in orthopedic billing and compliance.

Arineta's SpotLight(TM) Duo cardiac CT scanner has received U.S. Food and Drug Administration (FDA) 501(k) clearance for expanded use in low-dose cancer screenings (LDCTs). According to Arineta's press release, this clearance will allow providers to "use a single ultra-fast CT platform for both cardiac and lung imaging and diagnostics, delivering more complete care to high-risk patients."

The company states their scanner is the world's first cardiovascular and thoracic CT that can provide two life-saving scans with a single pass, capturing diagnostic images of the entire heart in a single beat with 140 mm coverage at a rotation speed of 0.24 sec per rotation.

Medical necessity denials remain a significant challenge for healthcare organizations, often resulting in delayed reimbursement, increased administrative burden, and potential revenue loss. Unlike other categories, these denials can be particularly difficult to resolve as they frequently involve complex payer policies, coding nuances, and, at times, extensive documentation requirements.

​As we approach the halfway point of 2025, it is time to begin looking forward to CY 2026. In preparation, there are several coding updates on the way from the American Medical Association (AMA) as part of the CPT® Editorial Panel Meetings, which concluded for 2026 in 2024. The summaries are published by the AMA on their website. 

​The following tables outline the changes we know to this point for specialties such as radiation oncology, diagnostic radiology, and interventional radiology with more information expected in the proposed outpatient rules from the Centers for Medicare and Medicaid Services (CMS) in July 2025 and the AMA publication of the 2026 CPT® manual, fourth quarter 2025. 

​Many healthcare professionals rely solely on denied claim data to monitor denials. While this approach is logical, since denial data highlights the reasons for non-payment, services being denied, and responsible payers, it shows only part of the picture. Transaction and accounts receivable data also provide valuable denial insight. 

​​Identifying denial trends is essential for addressing internal process gaps, but it is equally important to understand the broader financial impact these denials pose.

In accordance with Section 1833(t)(6)(B) of the Social Security Act, the Hospital Outpatient Prospective Payment System (HOPPS) requires that categories of medical devices be eligible for transitional pass-through payments for a minimum of two years and a maximum of three years. Additionally, Section 1833(t)(6)(B)(ii)(IV) of the Act mandates the creation of new device categories when novel medical technologies are not adequately represented by existing or former device categories.

On March 15, 2025, the President signed into law the Full-Year Continuing Appropriations and Extensions Act of 2025 (H.R.1968) to maintain federal funding and extend temporary Medicare telehealth flexibilities through September 30, 2025, which is the end of the fiscal year (FY). However, this spending package excluded the so-called "doc fix" to reverse the 2.83 percent Medicare pay cut for physicians which was effective January 1, 2025.

There is one denial reason code that consistently ranks among the top denied categories in every organization, yet it is rarely discussed. One payer response that no one wants to see is CO-16. This code requires additional effort on the backend to ensure the claim is fully paid. Sometimes, it can feel like a guessing game when trying to interpret what the payer truly requires with this reason code. To prevent “other documentation” denials, organizations must be proactive in identifying the root cause and implementing workflows for future prevention. 

​On Friday, January 31, 2025, a bipartisan coalition of lawmakers reintroduced a bill aimed at counteracting and surpassing a recent pay reduction for physicians that took effect at the beginning of the year. The Medicare Patient Access and Practice Stabilization Act of 2025, effective April 1, 2025, would continue the 2.83 percent Medicare pay reduction for services provided from January through March. However, starting April 1, 2025, through December 31, 2025, the legislation would implement a 6.62 percent increase, offsetting the previous payment cut and the impact of the first quarter’s reductions while adjusting for inflation.