July 1, 2026

Celebrating Susie Keller's Leadership and Announcing Her Upcoming Retirement

After nineteen years of dedicated service to the Idaho Medical Association (IMA), CEO Susie Keller has announced that she will retire at the end of 2026.

Keller joined IMA in November 2007, becoming only the fourth CEO in the organization's 130-year history—and the first woman to hold the position. Building on a decade of prior leadership with the Wyoming Medical Society, she brought deep experience in physician advocacy and a broad understanding of the complex issues facing healthcare systems and medical professionals.

During her tenure, Keller has guided IMA through a period of remarkable growth, influence and stability. She played a pivotal role in advancing one of the most significant healthcare milestones in Idaho's history, leading IMA's participation in the Close the Gap Coalition and the Idahoans for Healthcare campaign that successfully passed Medicaid Expansion, while continuing to champion and protect the program.

A recognized leader in physician workforce development, Keller has represented IMA on numerous statewide and national initiatives focused on medical education and training. Her work has helped shape efforts through the State Board of Education's Graduate Medical Education Committee, legislative working groups, and advisory roles with programs such as WWAMI, the Idaho College of Osteopathic Medicine, and the University of Idaho. She is widely respected for her expertise in physician recruitment, retention and training.

Keller oversaw establishment of the IMA Foundation, the organization's 501(c)(3) arm, which supports the next generation of physicians through scholarships, grants, and investments in education, training and retention across Idaho. Her leadership also extended to public awareness and advocacy initiatives including the development and fundraising of the Idahoans for Healthy Moms campaign.

Internally, Keller modernized IMA's operations and strengthened its financial position—implementing systems and structures that enhanced member engagement, transparency, and service delivery. From 2007 to 2025, IMA's financial reserves increased by 229%, and membership rose by 147%, placing the organization on strong financial footing and exceeding industry benchmarks at a time when many state medical associations face significant challenges.

Equally impactful has been Keller's commitment to fostering a culture of respect, collaboration, and open dialogue. In an increasingly polarized environment, she has worked to ensure IMA remains a trusted, inclusive forum where diverse perspectives are welcomed and difficult conversations can take place. Under her leadership, the association has earned a strong reputation among policymakers, legislators, and healthcare leaders as a credible and thoughtful voice for Idaho physicians.

"It has been an honor to serve Idaho physicians and work alongside such passionate members, partners, and staff," said Keller. "I am proud of what we've accomplished together and confident in the bright future ahead for this organization."

The IMA Board of Trustees has initiated a national search for the organization's next CEO and will share additional information about the transition process in the coming weeks.

"On behalf of the Board, we are deeply grateful for Susie's leadership and lasting contributions," said IMA President Megan Kasper, MD. "Her vision, integrity and dedication have positioned IMA for continued success. We are committed to ensuring a thoughtful transition and maintaining the strong momentum she has built."

Please join us in celebrating Susie Keller's extraordinary leadership and enduring contributions to Idaho's physician community.

IMA Delegates Represent Idaho Physicians at AMA Annual Meeting

By Patrice Burgess, MD

The AMA Annual meeting took place on June 5-10 in Chicago. You were well-represented by your mighty Idaho contingent! Our fearless leaders: Susie Keller, CEO, and Megan Kasper, MD, President, and your delegation team: Patrice Burgess, MD, Delegate; Zach Warnock, MD, Alternate Delegate; and Joey Florence, MD, YPS Delegate.

We actively participated in the deliberations around the resolutions on the online reference committees, PacWest Caucus meetings, in-person reference committees, and House of Delegates deliberations.

We also attended multiple events including the always inspirational AMA Foundation of Excellence Awards, where honorees are recognized for their volunteerism, community engagement, and dedication to underserved populations; the AMPAC 65th year celebration (the AMA Political Action Committee); and the inauguration of the new AMA President, Willie Underwood, MD, where Dr. Kasper represented Idaho on the big stage with all of the other state presidents!

The new AMA President-Elect is Sandra Fryhofer, MD. You may have seen some press about this as Dr. Fryhofer was formerly the AMA's liaison to the Center for Disease Control and Prevention's Advisory Committee on Immunization Practices, which was disbanded by the Trump administration earlier this year. Dr. Fryhofer's election was viewed by many as symbolic of the AMA's support for vaccines and public health.

Many issues were discussed and addressed affecting the practice of medicine as well as public health, including the role of AI in healthcare, food as medicine, prior authorization reform, and more. I encourage you to visit the AMA website to review more details.

As a reminder, the AMA House of Delegates represents well over 90% of practicing physicians as the leaders of all of the states and the vast majority of specialty societies compose the delegates that vote on the issues. Please consider joining or renewing your AMA membership as well as contributing to AMPAC to support the important work the organization does on behalf of our profession.

Help Shape IMA Policy: Join the Kratom Working Group

During its May meeting, the IMA Board of Trustees voted to establish a Kratom Working Group under the Public Health Committee. The working group is intended to bring together a broad range of IMA voices and expertise to evaluate IMA's current policy on kratom and recommend updates for consideration by the House of Delegates (HOD).

This is an important opportunity for members to help shape IMA's policy on an issue that continues to generate significant public health and legislative discussion. Your participation will help ensure IMA's policy is informed by physician expertise and reflects firsthand concerns as they continue to emerge across Idaho. Following those internal discussions, IMA anticipates inviting additional stakeholders to participate in a broader conversation about potential next steps legislatively.

Members interested in participating, or those with additional questions, should contact Mike Cunnington at cunnington@idmed.org.

Modifier 25: Understanding the Difference Between AMA Guidance and Medicare Policy

Modifier 25 continues to be one of the most scrutinized modifiers in medical coding and auditing. While the American Medical Association (AMA) provides guidance through CPT® and CPT Assistant publications (see link below), Medicare contractors such as Noridian process claims according to CMS regulations and National Correct Coding Initiative (NCCI) policy. Although there is significant overlap between the two, important differences exist that providers should understand to avoid denials, audits, and compliance risk.

The AMA defines Modifier 25 as a significant, separately identifiable Evaluation and Management (E/M) service performed by the same physician or qualified healthcare professional on the same day as another procedure or service. According to the AMA, the E/M service must be above and beyond the work normally associated with the procedure and supported by documentation meeting the requirements of the reported E/M service. The AMA further notes that the E/M service may be prompted by the same condition that led to the procedure and does not require a different diagnosis. The AMA publication provides several examples where an E/M service may be reported with Modifier 25, including procedures such as laryngoscopy, skin biopsy, fine-needle aspiration, catheterization, and preventive medicine services.

However, Noridian has clarified that it cannot endorse the AMA publication because CMS policy differs in several key areas. First, CMS generally allows only one E/M service per provider, per patient, per day. While the AMA discusses circumstances where multiple E/M services may be reported on the same date, Medicare policy generally requires services occurring on the same day to be combined into a single E/M service unless a rare circumstance occurs, such as a patient experiencing an emergency event later in the day that necessitates a separate evaluation.

A second distinction involves the use of Modifier 57. The AMA states that Modifier 25 should not be used when the E/M service results in the decision to perform surgery and instead directs providers to report Modifier 57. CMS narrows this application by limiting Modifier 57 to major surgical procedures, generally those within a 90-day global period. For minor procedures with a 0- or 10-day global period, the decision to perform the procedure is included in the procedure payment and is not separately billable as an E/M service.

Perhaps the most significant difference relates to new patient visits. The AMA includes examples where a new patient E/M service may be reported with Modifier 25. CMS, however, specifically states that the fact a patient is new to the provider does not, by itself, justify reporting a separate E/M service. Under NCCI policy, the work associated with evaluating the condition that leads to a minor procedure is included in the procedure payment regardless of whether the patient is new or established. A separately billable E/M service must address work beyond the evaluation associated with the decision to perform the minor procedure. Further, New patient visits are excluded from modifier 25 prepayment edits.

CMS guidance further emphasizes that minor surgical procedures (those with 000- or 010-day global periods) include the decision to perform the procedure. For providers billing Medicare, the safest approach is to view AMA guidance as coding guidance and CMS/Noridian policy as payment policy. When reporting Modifier 25, providers should ensure documentation clearly demonstrates a medically necessary E/M service that extends beyond the work inherent to the procedure and understand that Medicare's interpretation may be more restrictive than the AMA examples suggest.

References

• AMA CPT Assistant, Reporting CPT Modifier 25 (November 2023)
• CMS Medicare Claims Processing Manual (IOM 100-04), Chapter 12, Sections 30.6.6.B and 40.3.
• National Correct Coding Initiative (NCCI) Policy Manual, Chapter 1, Section E and Chapter 11, Section U