CodeCast | Medical Billing and Coding Insights

CodeCast | Medical Billing and Coding Insights

Taking the Business of Medicine to the next level

Episodes

July 16, 2024 16 mins

Terry discusses when it is and isn’t appropriate to report a preventative visit with an office visit on the same date. How did the patient present? What is the share of the cost-to-patient implications? And what will payers want to see for medical necessity? Terry covers it all in this edition of CodeCast podcast. Subscribe […]

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In today’s episode of the CodeCast podcast, Terry updates you on the latest CMS NCCI Edits, effective July 1st. She gives you the insight on the PTP and MUEs expected, along with some commentary and best practices on charging patients for no-show appointments. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts […]

The post NCCI Updates 30.2 and No Show Appointments appeared first on Terry Fletcher Consulting...

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July 2, 2024 13 mins

Principal Care Management (PCM) services are services for a single high-risk disease, 30 minutes a month, personally provided by a physician or NPP. This is for patients with one complex chronic condition expected to last three months which places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death. Does your patient […]

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Can you guess the main reason why medical billing claims are rejected? According to recent studies, most clinics account for 15-25% of inaccurately submitted monthly claims. Those inaccuracies must be corrected, resulting in an annual loss of revenue worth tens of thousands of dollars. Among the most popular reasons medical claims return to a clinic […]

The post Top 10 Coding and Billing Mistakes – Let’s Fix It! appeared first on T...

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You must make sure your providers and coders understand the overarching LCD criteria for reporting TPIs (Trigger Point Injections). As of April 1st, five MACs have tightened their rules for TPI coding and reporting. There are new frequencies, ICD-10-CM, anatomical territories, and MUE rules for these services. Terry outlines the rules and reminds practices that […]

The post Trigger Point Injections and LCDs appeared first on Terry ...

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How do you know if your role is classified as a Coder or a Biller? Coders typically work in the back end of the facility, focused on interpreting medical records and assigning appropriate codes. Billers interact directly with patients, collecting payments and entering patient information into the appropriate systems. However, there is also a crossover […]

The post Are you a Coder or a Biller? appeared first on Terry Fletcher Consul...

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All CPT codes have an expected range of complexity and uses, but when a particular procedure or surgery performed has exceeded the normal range of complexity, modifier -22 can come into play. Modifier -22 is defined as increased procedural services and demonstrates when a physician has gone above and beyond the typical framework of a […]

The post When To Use The -22 Modifier appeared first on Terry Fletcher Consulting, Inc..

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This week on the CodeCast podcast Terry returns with her Top 10 Tuesday Q&A series. Join us as Terry covers questions from Urgent Care to the ER, infusion charges, behavioral health, billing for unlisted codes, preventative med group codes, and more. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 […]

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May 21, 2024 16 mins

Are you a “Subject Matter Expert?” Are you taking on clients, presenting to physicians, or looking for a coding job: with no expertise? Do not “wing it” in the healthcare field. You will hurt yourself or your credibility unless you disclose your limitations to the person you are doing business with. (Not to mention potentially […]

The post Are you a real SME? appeared first on Terry Fletcher Consulting, Inc..

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Many of the records Terry audits include a disclaimer to protect a physician from liability. However, does this disclaimer shield a physician who has signed a note or authenticated an electronic encounter? (Under the assumption the physician reviewed it?) In this episode of the CodeCast podcast, Terry discusses the protections of a disclaimer and whether this […]

The post Is a Medical Record “Errors Disclaimer” Valid? appeared firs...

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May 7, 2024 12 mins

In this episode of the CodeCast podcast, Terry discusses the frequent urgent care center encounters that elevate to the patient going to the ER. Is this considered automatically high risk? So many providers want level 5, but what if it’s to get testing or services unavailable at the UC? Terry discusses the complexities and compliance […]

The post Urgent Care to ER Coding appeared first on Terry Fletcher Consulting, Inc..

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This week’s CodeCast Podcast is all about coding and billing. Join Terry for a full deck of important information on Coding, Billing, and Compliance. Get answers to our top ten questions including eVisit POS, LE Thombectomy services, SDoH assessment codes, Data Point E/M clarifications, and more. Subscribe and Listen You can subscribe to our podcasts […]

The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appear...

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April 23, 2024 19 mins

This week on the CodeCast Podcast Terry dives into the new rules for hernia repair codes. Terry discusses when the 0-global-days and 90-day-global-days services are billed on the same date. What applies? What about co-surgery? What about follow-up visits, or add-on codes for staple/suture removal? Tune in to find out details about these topics and […]

The post Coding Hernia Repairs in 2024 appeared first on Terry Fletcher Consultin...

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Some procedures in the CPT book are listed as “separate procedures” meaning they are commonly carried out as an integral component of a total service or procedure that has already been identified. In this episode, Terry discusses if, and when, you can report these with a code for the total procedure if modifiers will help, […]

The post What does “separate procedure” mean in CPT? appeared first on Terry Fletcher Consulting, Inc..

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April 9, 2024 12 mins

TPE audits from Medicare, along with private and commercial payer audits are on the rise. It is more important than ever to monitor physician records and make sure that when they submit any level of E/M. (Especially level 4’s and level 5’s.) In this episode, Terry reinforces making sure the visit not only meets the […]

The post Is This Really Medically Necessary? appeared first on Terry Fletcher Consulting, Inc..

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April 2, 2024 14 mins

There will be more over-coding and overreaching with the additional codes Medicare provides to capture services. This episode explains the distinction for code G0136 and why it isn’t a “screening” service (as per CMS) but an assessment. Terry discusses the new SDoH assessment code and when it should and shouldn’t be billed. We previously discussed how […]

The post Revisiting SDoH G0136 Reporting appeared first on Terry Fletcher Con...

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In this Top Ten Q&A episode, Terry tackles what the focus of any telehealth audit should be. Auditing Telehealth encounters is more that just looking at the coding. It should also include medical necessity, the technical and procedural aspects of the service, and on patient satisfaction and outcomes. She also recommends an external audit if […]

The post Top 10 Tuesday Q&A – Auditing Telehealth appeared first on Terry Fletcher Consu...

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You must have a collaboration agreement in place when hiring mid-level providers or QHPs (such as nurse practitioners, physician assistants, or clinical nurse specialists) to act on your behalf with treating patients. Collaboration agreements are mandatory in most states but rules differ from state to state. Also, due to failed compliance policies, lack of understanding […]

The post Compliance Issues With MD/QHP Collaboration Agree...

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March 12, 2024 19 mins

Critical care in 2024 can be tricky, with inclusions, carve-outs, and a time component. Are there exceptions when PA/NPs are involved in critical care services? What has to be documented? You may find some rules you didn’t know about. Terry has all of the answers in this episode of the CodeCast podcast, sponsored by Decision […]

The post Critical Care Inclusions and Carve-Outs appeared first on Terry Fletcher Consulting, Inc..

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What happens when a provider meets with a family to discuss and develop a care plan for patients? Providers will give the parent the option to have the patient present or just the parent/guardian due to the sensitivity of the discussion. Some scenarios where this may occur are cancer patients where the family wants to […]

The post Can you bill an E/M service when the patient isn’t present? appeared first on Terry Fletcher Consultin...

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