Podcasts

The CodeCast Podcast | Medical Billing & Coding Insights

The Business Side of Medicine ~ Coding, Reimbursement and Compliance for Physician Practices

National Speaker and Healthcare Consultant, Auditor and Educator, Terry Fletcher CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, , ACS-CA, SCP-CA, QMGC, QMCRC, QMPM knows from over 30 years medical reimbursement industry experience that Coding, Billing and Compliance for physician practices and hospitals can be tough to navigate. Her CodeCast® Podcast series will share insights to current rules and regulations the Medicare payer requires, along with Commercial Insurance plans’ rules and reimbursement challenges. Discover revenue opportunities to maximize reimbursement in your medical practice, focusing on different medical specialties and platforms each episode.

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Patient History = Medical Necessity

Patient History = Medical Necessity

December 5, 2023

In the ICD-10-CM guidelines, there is an entry for only history codes at I.C.21.c.4, and there are two types of history Z codes: personal and family. History codes can be …

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Transitional Care Management Services

Transitional Care Management Services

November 28, 2023

Care Management services are being reported at an all-time high but they are not all alike. Before submitting claims, many providers have not read the directions — or CPT-published guidance …

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Telehealth CPT 2024 Rules

Telehealth CPT 2024 Rules

November 21, 2023

After all of the CMS continued updates for Telehealth, we finally got an update from the AMA, that was added to CPT 2024. This gives us the “criteria” on how …

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E/M Leveling with MDM: Right or Wrong?

E/M Leveling with MDM: Right or Wrong?

November 14, 2023

Leveling an E/M visit can be considered very subjective. Clinicians and auditors alike can come to one conclusion or another. It is important that when you take online advice, you …

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Final Rule 2024 Shared/Split Visit

Final Rule 2024 Shared/Split Visit

November 7, 2023

The 2024 Medicare Final Rule was published on November 2nd, and the Split/Shared visit guidance will parallel the CPT guidance. However, CMS will still expect the -FS modifier from the …

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Top 10 Tuesday Q&A – Halloween Episode

Top 10 Tuesday Q&A – Halloween Episode

October 31, 2023

Join us for a great Halloween episode as Terry provides the top ten spookiest ICD-10-CM codes. She also discusses preventative and OV on the same date. And what happens when …

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CMS clarifies how to respond to a CERT audit

CMS clarifies how to respond to a CERT audit

October 24, 2023

CMS recently updated their published guidance, MLN909160 July 2023, with further examples and instructions on how to gather information and documentation when a CERT Audit issues a request for an …

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Is your CDI compromised by dated EMR entries?

Is your CDI compromised by dated EMR entries?

October 17, 2023

Clinical Documentation Integrity, or CID, is important. Outdated information, or information that doesn’t make sense for that date of service encounter, brings into question the reliability of the entire patient …

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A Look Ahead at the 2024 CPT

A Look ahead to the 2024 CPT codes

October 10, 2023

The 2024 CPT codes have been released. Terry briefly looks at the additions, revisions, and deletions and what the E/M code descriptors are revising. Terry will also offer her last …

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Modifier 25

Modifier 25

October 3, 2023

The CPT definition of a significant, separately identifiable service relies on determining the correct level of E/M service to be reported. Terry discusses what questions should be asked before you …

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Are you blurring the lines on who's a doctor or a nurse?

Are you blurring the lines on who’s a doctor or a nurse?

September 26, 2023

Physicians are educated and trained more extensively than any other healthcare professional. A misrepresentation of a practitioner’s level of licensing, i.e., using the clinical term “doctor” when there is no …

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Understanding Prior Authorization

Understanding Prior Authorization

September 19, 2023

Prior authorization in health care is a requirement that a healthcare provider gets approval from an insurance plan before prescribing their patient medication or doing a medical procedure. Insurance providers …

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EM Data Points Confusion Clarifications

EM Data Points Confusion Clarifications

September 12, 2023

The AMA MDM directions when leveling an E/M (Evaluation and Management) code (also known as office and/or hospital visits) are still confusing many providers, coders and auditors. In this week’s …

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What is the G2211 complexity add-on for 2024?

What is the G2211 complexity add-on for 2024?

September 5, 2023

In 2024, there will be a new add-on code for Medicare. This is a complexity code for specific long-term patients, where the provider is taking the treatment journey with the …

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Top 10 Tuesday Q&A – Coding, Billing and Compliance Questions

Top 10 Tuesday Q&A – Coding, Billing and Compliance Questions

August 29, 2023

In this week’s CodeCast podcast, Terry discusses the top ten coding, billing, and compliance questions from the last month. In this information-filled episode, she covers coding for staff prolonged services …

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Waiving Co-Pays and Deductibles

Waiving Co-Pays and Deductibles

August 22, 2023

Providers sometimes waive patients’ cost‐sharing amounts (e.g., copays or deductibles) as an accommodation to the patient. However, doing so may violate fraud and abuse laws and/or payor contracts. From a …

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What's The Latest Medicare Update?

What’s The Latest Medicare Update?

August 15, 2023

Medicare has been making some under-the-radar updates that provider practices need to know. You could be seeing ineligible patients, with no current ID card, coming in for services. You could …

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Can Pre-Op Visits Be Billed?

Can Pre-Op Visits Be Billed?

August 8, 2023

A question that Terry often fields is one regarding billing for pre-op visits. Should these visits be billing? There is conflicting published guidance on this question from different sources. Terry …

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