CodeCast | Medical Billing and Coding Insights
Taking the Business of Medicine to the next level
Episodes
Since the implementation of the No Surprises Act (NSA) in January 2022, out-of-network (OON) reimbursement has become a complex and resource-heavy challenge for hospital and health system revenue cycle leaders. Although designed to shield patients from unexpected medical bills, the legislation has placed continuous financial pressure on physician practices and hospital systems. It has led […]
The post No Surprises Act and OON Claim...
Medical necessity is defined as services that are reasonable and necessary for diagnosis or treatment of an illness or injury, or to improve the functioning of a malformed body member and are not excluded under another provision of the Medicare Program. Unfortunately, we have many practices trying to slide under the radar the experimental and/or […]
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Terry discusses Behavioral Health services, best practices documentation and coding specifics. Also, Terry offers some bonus discussion on RAC auditors trying to bait providers into not responding to ADR requests. Check out this episode for intel on these important topics and more. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – […]
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With all of the AI implementation into EHR and EMR systems, there is concern about how providers rely on these AI shortcuts more than ever. Without proper safeguards, accountability, and compliance perimeters, relying on AI could be problematic. Terry discusses the red flags to look for and how to proceed with caution in this new […]
The post Did you know AI is integrated into EMRs? appeared first on Terry Fletcher Consulting, Inc....
The 2023 CPT® Errata and Technical Corrections added a one-liner on Independent Interpretations that responds to the question, “Can a practitioner get credit for both ordering and interpretation of a test, if documented?” In this episode of the CodeCast podcast, Terry answers this question referencing the March 2023 CPT® Errata and Technical Corrections. She also […]
The post Can you get credit for ordering and interpretation of a ...
The 2021/2023 E/M guideline revisions read: “The evaluation and/or treatment should be consistent with the likely nature of the condition.” Before this, the CPT® guidelines did not discuss medical necessity. Guidance was left to the payers, particularly Medicare, via the Social Security Act. CMS’s guidance doesn’t necessarily hold regulatory authority. However, it often reflects a new, shared […]
The post Medical Necessity Comes Be...
It’s time for another round of frequently asked questions as Terry’s expertise covers orthopedic surgery, imaging, data points for E/M, and administrative charges for practices. She also answers questions relating to multiple E/Ms on the same date by the same and different physicians from the same group practice. Tune in for a lot of good […]
The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on ...
We all know the age-old question, “Where does it say that?” In this episode, Terry brings receipts, explaining it’s been this way since 2003: “Reviewing results of laboratory tests, phoning results to patients, filing such results, etc., are Medicare-covered services. Payment is included in the physician fee schedule payment for the evaluation and management (E/M) services to […]
An ADR (Additional Documentation Request) is a request from CMS or another insurance payer for additional documentation to review a claim. Most of these requests come from payer investigative units looking for medical necessity support. Terry discusses how to handle these requests, as well as how to ensure they are addressed promptly to meet the […]
The post ADR Workflow Tips appeared first on Terry Fletcher Consulting, Inc..
If the provider discusses their preferred management options with the patient, do they receive the “risk” credit even if the patient declines it? If yes, how long do they get to capture it? Terry breaks down, citing references, how to handle this MR element and ensure the providers are receiving the correct “risk” value for […]
The post Who Gets the Credit for MDM Risk Element? appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast podcast, Terry discusses the differences between APCM and CCM services and what is needed to report either. Compliance issues are seen with many care management service records. Terry covers how to follow best practices to ensure you follow the published guidance. Subscribe and Listen You can subscribe to our […]
The post APCM Focus appeared first on Terry Fletcher Consulting, Inc..
Medical Coding provides standardized language that ensures all healthcare providers involved in a patient’s care are on the same page. The coder’s role is to be accurate, communicative, insightful and focused on a positive patient outcome. A patient’s financial health can impact their clinical health, and medical coders need to be recognized for their role […]
The post The Crucial Role of the Coder in Quality Patient Care appeared ...
This week’s CodeCast summarizes the recent ICD-10-CM documentation guidelines instructions on sepsis, obesity, and COVID-19 reporting. Terry also provides more guidance on E/M risk in prescription drug management and caution with PSAs in patient documentation. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spoti...
More medical claims denials could be avoided if coders took the extra minute to make sure that the diagnoses that need to be linked to a specific line item were pre-billed. Also, when billing for diagnostic procedures on a complaint that moves to a minor, therapeutic, or surgical procedure, denials will happen when the diagnosis […]
The post Avoiding Insurance Denials appeared first on Terry Fletcher Consulting, Inc..
Terry takes some inspiration from Stephanie Allard’s February 27th for this edition of the CodeCast podcast. Terry discusses the differences and subjective issues between Acute Uncomplicated Illness (or Injury) versus Acute Complicated Illness in the E/M elements of coding and auditing. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-...
Terry’s answering your coding questions in this week’s “Top 10” Q&A. In this episode Terry’s covering APCM, E/M, skin procedures, lab billing, and even a Telehealth bonus. Tune in for insights you won’t want to miss! Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify – https://open.spotify.com/show/1lA69Q7En...
Terry is under the weather this week, so she gives us a quick segment on the E/M Data point, “independent interpretation”. See page 12 of CPT® under independent interpretation, the last sentence. “A test that is ordered and independently interpreted may count as both a test ordered and interpreted.” Suppose you bill for the professional and […]
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Some coders remain confused about Medically Unlikely Edits (MUEs) — but that’s about to change. In this episode, Terry discusses denials from Part B MACs for what you may think is an undetermined reason. However, a possibility is running up against MUEs. The edits, which are designed to prevent over-payments caused by serious billing errors, […]
The post How do MUEs Work in Coding? appeared first on Terry Fletcher Consulting, Inc..
The third element of MDM for E/M Services is “Risk of Complications and/or Morbidity or Mortality of Patient Management”. Many believe that only the risk in this element is how you level your E/M, but that is false. There are three elements to a E/M service when using MDM. There are several risks including the […]
The post E/M MDM Third Element Complications appeared first on Terry Fletcher Consulting, Inc..
Everyone knows that you cannot routinely waive or fail to collect the obligation of patient cost-sharing. However, we know that there are instances where (1) the patient has a bad experience, (2) the patient will not pay or is not collectible, and (3) the patient has a hardship. Here are several policies your practices can […]
The post Professional Courtesy appeared first on Terry Fletcher Consulting, Inc..
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