CodeCast | Medical Billing and Coding Insights: Recent Episodes
Terry Fletcher
What are we anticipating for 2027 in the MPFS? This week Terry gives us a rundown on what to expect, how to respond before the comment period ends, and what needs to happen to strengthen our private practice providers. Listen in…
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The post CMS Fee Schedule Proposals appeared first on Terry Fletcher Consulting, Inc..
Incident-to Billing Update: More Blue Cross Blue Shield plans, along with the three largest commercial insurance carriers, are tightening their policies on the reporting and reimbursement of services billed under Medicare’s “incident-to” guidelines.
In today’s episode of the CodeCast Podcast, Terry reviews these recent policy changes, highlights key effective dates, and explains what physicians, coders, billers, and practice managers need to know before submitting claims. Tune in to learn how these evolving payer requirements could impact your reimbursement and the compliance steps you should be taking now.
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The post Incident to Update: Commercial Plans appeared first on Terry Fletcher Consulting, Inc..
With more patients turning to large-language models such as ChatGPT, Gemini, Claude and others to answer their questions about symptoms, medical conditions and more, the American Medical Association (AMA) is offering some go-to advice that will help patients get more out of their experience with AI chatbots while staying safe.
The key to effectively using AI chatbots, is to understand they are not a replacement for a physician. Terry discusses the AMA 5 steps to AI ChatBot safety and what physician practices need to do to protect patients in this uncertain and sometimes, unchecked reality. AI chatbots are not as a substitute for the evidence-based, personalized guidance of an actual doctor.
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The post AI ChatBots Are Not Physicians appeared first on Terry Fletcher Consulting, Inc..
In today’s episode of the CodeCast podcast, we’re breaking down why E/M time belongs to the physician or qualified healthcare professional performing the service, why time from other team members cannot be combined to support the E/M level (in the office setting), and an important Medicare reminder: shared visits do not apply in the office or other outpatient setting.
Let’s dive into the rules so you can code with confidence and avoid a common compliance pitfall.
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The post Can ancillary staff be part of shared services under E/M? appeared first on Terry Fletcher Consulting, Inc..
Terry tackles a growing compliance issue in telehealth: where the patient is located at the time of the visit. While physicians generally must be licensed or otherwise authorized to practice in the state where the patient is physically located, evolving payer policies and Medicare rules have added new layers of complexity.
From commercial insurance requirements to CMS guidance on services provided outside the United States, Terry explains what providers need to know to remain compliant and avoid costly reimbursement pitfalls.
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The post Telehealth: Where the Patient is or Where the Provider is? appeared first on Terry Fletcher Consulting, Inc..
Artificial intelligence is advancing faster than the laws designed to regulate it. While individual states continue to enact legislation governing the development and use of AI, the federal government is simultaneously working toward a nationwide regulatory framework that could preempt many state laws.
In this episode of the CodeCast Podcast, Terry examines the evolving legal landscape surrounding AI, the current lack of mandated safeguards, and the ongoing tension between state and federal oversight. She also discusses the compliance and operational risks healthcare organizations should be considering now, along with practical best practices to help mitigate those risks as AI becomes increasingly integrated into healthcare.
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The post How Safe Is AI in Healthcare? appeared first on Terry Fletcher Consulting, Inc..
Every CMS-1500 claim includes a set of certifications, attestations, and legal statements printed on the reverse side of the form. While these statements may seem like standard administrative language that has been around for decades, they carry significant legal and compliance implications.
In this episode, Terry breaks down what these certifications actually mean and why every claim submitted is a legal representation that the services billed were properly documented, medically necessary, accurately coded, and provided in compliance with applicable regulations. She also explains why understanding these attestations is essential to maintaining a strong revenue cycle management (RCM) workflow, reducing compliance risk, and helping organizations avoid costly payer audits.
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The post CMS-1500 Form Compliance appeared first on Terry Fletcher Consulting, Inc..
Released on June 5, 2026, the ICD-10-CM update includes 190 new codes, 30 deleted codes, and four revised codes. While these changes take effect on October 1, 2026, they are considered part of the FY 2027 ICD-10-CM update because the code set follows the federal fiscal year publication cycle.
In today’s episode, Terry breaks down some of the most notable additions and revisions, explains what healthcare professionals need to know before implementation, and shares practical insights on how these updates may impact coding and documentation. As a bonus, Terry also addresses a telehealth question that continues to generate confusion and discussion across the industry.
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The post Preparing for the 2027 ICD-10-CM Updates appeared first on Terry Fletcher Consulting, Inc..
A growing concern among auditors, coders, and compliance professionals is the increasing reliance on template driven documentation. While electronic health records have improved efficiency, copied, carried-forward, and pre-populated information can create significant compliance risks when it does not accurately reflect the patient’s current encounter.
Auditors frequently identify contradictory statements, outdated histories, normal findings that conflict with the assessment and plan, and documentation that appears disconnected from the services actually provided. Simply completing documentation fields does not create credible documentation.
On this episode of the CodeCast Podcast, Terry discusses why E/M documentation is not a checklist, the compliance risks associated with template generated notes, and practical strategies to ensure your documentation accurately tells the patient’s story and supports the care delivered.
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The post E/M Documentation Is Not a Checklist: Tell the Patient’s Story appeared first on Terry Fletcher Consulting, Inc..
At some point, we have to stop and ask ourselves: What are we truly building for our future? Where is our career in healthcare going?
I have all of these credentials in coding, billing, compliance, practice management, and prior authorization, but what does that really say about me? I want to be clear that I believe credentials matter. I know the work, time, money, and dedication it takes to earn them. However, we also need to be honest with ourselves about something that is becoming increasingly obvious in healthcare: collecting credentials alone is not a career plan. AI is changing healthcare, and we need to start looking at the bigger picture.
Terry discusses what that means in today’s episode of the CodeCast podcast and asks the questions that may be uncomfortable to consider.
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The post Credentials Alone Are Not a Career Path in Healthcare appeared first on Terry Fletcher Consulting, Inc..
Auditors, coders, billers, and even physicians often find themselves searching through pages of documentation trying to answer one basic question: what was actually evaluated, managed, and medically necessary during a single patient visit?
With note bloat from copied and pasted EMR documentation and pulled-forward notes, it has become increasingly difficult to determine what actually happened “today.” In this episode of the CodeCast Podcast, Terry breaks down this compliance challenge and explains how providers can better manage documentation to ensure accuracy, clarity, and compliance.
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The post Note Bloat Is an Auditor’s Nightmare appeared first on Terry Fletcher Consulting, Inc..
Text messaging for communicating orders is not prohibited by CMS or The Joint Commission, but there are important HIPAA privacy and security considerations that healthcare organizations must understand before using this method of communication. According to guidance from the AMA, providers must evaluate compliance requirements and safeguards when using text messages in patient care workflows. In this episode, Terry explains the details of using text messaging for orders, what organizations need to know to remain compliant, and practical considerations for implementation. Plus, hear about a newly accepted AMA CPT Committee decision for 2027 that could impact future coding and reporting.
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The post Can Physicians and Clinicians Use Texting for Patient Care? appeared first on Terry Fletcher Consulting, Inc..
HHS recently released updated Notices of Privacy Practices (NPPs), introducing changes that go far beyond standard template revisions. The update includes new requirements for health care providers, health plans, and Part 2 patient notices related to sensitive protected health information.
While many in health care associate “NPP” with Non-Physician Practitioner, in this case it refers to patient privacy notice requirements involving highly sensitive health information, including substance use disorders (SUD), reproductive health information, and mental health records.
These updated privacy notice requirements became effective February 16, 2026, and covered entities must comply by July 1, 2026. In this episode, Terry breaks down what has changed, what practices need to update immediately, and how to ensure your organization remains compliant with both HIPAA and the new federal privacy requirements surrounding sensitive PHI.
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The post Notice of Privacy Practices 2026 appeared first on Terry Fletcher Consulting, Inc..
Watch the claims data behind telehealth modifier 95 and audio-only modifier 93 as denial trends for high-volume CPT codes and place of service combinations raise major compliance concerns. Terry breaks down the most common causes of denials, including incorrect POS reporting, documentation gaps, and billing practices that could trigger audit scrutiny. She also explains why relying on coding forums for definitive coding advice can create serious compliance risks for providers and practices.
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The post Telehealth Modifiers 95 and 93 Compliance appeared first on Terry Fletcher Consulting, Inc..
While Centers for Medicare & Medicaid Services does not explicitly define a strict “12-month rule,” its guidance does require that the physician’s involvement reflect ongoing, active participation in the patient’s course of treatment.
That said, legal and compliance experts consistently caution that if a physician has not personally seen a patient within 12–24 months, billing subsequent non-physician practitioner (NPP) visits as “incident to” may present elevated audit risk. Terry breaks down the lack of clear regulatory thresholds and outlines practical steps to help protect your practice if an audit inquiry occurs.
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The post Incident to Physician Participation Rules appeared first on Terry Fletcher Consulting, Inc..
Terry breaks down a recent social media post that exposed a practice’s compliance issues with time based care management services, drawing exactly the kind of attention no organization wants. Although the original post was quickly deleted after backlash, the situation highlights a bigger issue.
In this episode, Terry emphasizes the importance of using sound judgment online and ensuring time based services are properly documented and driven by medical necessity, not simply billed because they can be.
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The post CCM and CoCM Compliance Risks on Social Media appeared first on Terry Fletcher Consulting, Inc..
Modifier 59 (Distinct Procedural Service) continues to face intense scrutiny in 2026 due to widespread misuse, triggering audits, denials, appeals, and payer recoupments tied to medical necessity concerns. With enforcement on the rise, it’s more important than ever for coders to understand when—and when not—to apply this modifier correctly.
On today’s episode of the CodeCast Podcast, Terry Fletcher breaks down proper Modifier 59 usage, common pitfalls leading to audits, and key documentation requirements to support compliant coding. She also covers post-operative pain injections, including when they can be reported and which providers are eligible to bill for them.
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The post Modifier 59 Audits Denials and Post-Op Pain Injections appeared first on Terry Fletcher Consulting, Inc..
Coding fracture care using CPT and ICD-10-CM can be challenging—especially when documentation from providers lacks key details. In this episode of the CodeCast Podcast, Terry breaks down exactly what coders should look for in physician notes, including essential documentation elements and common gaps. She also shares expert insights and practical tips to help ensure accurate coding, proper reporting, and compliance when working with fracture treatment cases.
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The post Fracture Coding Accuracy appeared first on Terry Fletcher Consulting, Inc..
In medical coding and compliance, attention is often focused on overcoding due to its association with fraud, waste, and abuse. However, undercoding is an equally important—and frequently misunderstood—issue. While it may seem like a safer way to avoid scrutiny, undercoding is still a coding error, a compliance concern, and a reportable variance under both CMS and OIG guidelines.
Recent TPE audits are increasingly targeting undercoding, as it signals a failure to accurately report services and can negatively impact compliance, data integrity, and reimbursement. In this episode, Terry breaks down why undercoding is now on the radar and why providers need to address it immediately.
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The post Undercoding Is Now a Compliance Risk Providers Can’t Ignore appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast Podcast, Terry Fletcher answers key medical coding and billing questions in a detailed Q&A session designed for coders, billers, auditors, and healthcare providers.
This episode covers E/M coding with minor procedures and when services can be billed separately, RTM (Remote Therapeutic Monitoring) for CPAP patients, CO-96 Medicare denials including what they mean and how to properly appeal, along with real-world coding scenarios and expert guidance to help improve reimbursement and reduce claim denials.
If you’re looking to stay compliant, optimize your coding practices, and better understand payer requirements, this episode delivers practical, actionable insights you can use immediately.
Be sure to subscribe to the CodeCast Podcast for weekly updates on medical coding, billing, and compliance.
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The post Top 10 Tuesday Medical Coding Q and A appeared first on Terry Fletcher Consulting, Inc..
You receive a payer inquiry questioning level 4 services… so you open the note and see:
“Patient here for follow-up. Doing well.”
That’s it.
Now you’re stuck defending a level of service that the documentation doesn’t support.
In this episode of the CodeCast podcast, Terry breaks down a common challenge in healthcare organizations—how to educate providers on documentation without defaulting to scolding or generic feedback that doesn’t stick.
Using real-world examples, Terry explains how to shift the conversation from criticism to clarity—helping providers understand how to document the patient story, support medical necessity, and protect reimbursement.
If your current education approach isn’t changing behavior—or your providers keep defaulting to template-style notes—this episode will give you practical, effective talking points that actually make a difference.
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The post Educating Physicians Without Scolding appeared first on Terry Fletcher Consulting, Inc..
If you spend your days auditing charts, you’ve seen it: diagnoses are listed, medications are “continued as prescribed,” and a plan is documented — yet something important is missing.
In this episode of CodeCast, Terry explains how small documentation improvements can make medical decision making (MDM) clearer and more defensible. Learn how generic or repetitive macro phrases can unintentionally invite payer scrutiny, and what clinicians can do to better reflect the true complexity of the encounter.
With payers increasingly using AI tools to review and downcode E/M services, clear documentation is more critical than ever. Every note should answer the essential question: Why is the patient here today?
Tune in for practical tips to strengthen your documentation and reduce audit risk.
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The post Moderate MDM — Is It Clear in the Medical Record? appeared first on Terry Fletcher Consulting, Inc..
A recurring question in Advanced Primary Care Management (APCM) is whether practices can bill every month for a patient once they’re enrolled — even if no services were provided during that month.
Terry’s stance is clear: no. APCM isn’t a subscription model or a gym membership. These are medically necessary services tied to ongoing clinical need, and billing without documented work invites unnecessary audit risk.
On today’s CodeCast, Terry breaks down why monthly billing without services is problematic, how other consultants interpret the rules, and what practices should consider to stay compliant.
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The post APCM Is Not a Gym Membership appeared first on Terry Fletcher Consulting, Inc..
Are your EMR templates helping—or hurting—your documentation? Terry dives into the difference between pre‑formatted templates and pre‑populated medical records, and why that distinction matters more than most providers realize. Pre‑populated fields can create inaccurate documentation, audit red flags, and even malpractice risk.
Terry also reviews a NAMAS article that sheds light on how this issue is showing up in real audits and what practices should watch for.
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The post Pre‑Populated EMRs Are Not Templates appeared first on Terry Fletcher Consulting, Inc..
Modifier 25 remains one of the most audited—and most overused—modifiers in medical coding. But the problem isn’t just coding mechanics. It’s about appropriateness, credibility, and documentation.
Designed to represent a significant, separately identifiable E/M service performed on the same day as a procedure, Modifier 25 is too often applied automatically, like scotch tape slapped on to avoid an edit denial. When the documentation doesn’t support it—or when the service isn’t truly separate—misuse doesn’t just trigger denials. It invites deeper scrutiny and puts the entire visit under the microscope.
Terry breaks down why Modifier 25 is so frequently misapplied and shares her smart, reliable method for determining when it’s actually necessary. Listen to today’s CodeCast to learn how to protect your claims, your documentation, and your credibility.
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The post Are You Misusing Modifier 25? appeared first on Terry Fletcher Consulting, Inc..
Many EMRs now embed ICD‑10 and CPT codes directly into the medical record. But is that advisable? The safest approach is still to let the documentation stand on its own. The content of the record should support the coding choices, and coders and auditors should base their work on the medical facts as documented. Codes can—and should—be applied only after the documentation is complete.
On today’s CodeCast episode, Terry explains that when providers insert billing codes into the note, the intention may be good, but the risk of contradictions or inaccuracies can outweigh any perceived benefit.
Should medical record documentation stand alone, without templated teaching language that was never meant to be included? Should codes appear in the record simply to give the impression of accuracy, rather than allowing the documentation to speak for itself?
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The post Who’s Doing the Coding — Providers or Coders? appeared first on Terry Fletcher Consulting, Inc..
When performing audits, the same macro statements keep appearing in progress notes: ambient AI scribing was used to create the documentation, and the note may contain errors. The pattern mirrors what happened when early talk‑to‑text tools rolled out. From a patient’s perspective—especially someone with little or no understanding of ambient AI scribing—this raises real questions about whether they truly understood what was used during their visit and what they were consenting to.
Terry breaks down this issue this week, drawing on an excellent article by Stephanie Allard, RHIT, to explore informed‑consent workflows, compliance expectations, and liability concerns surrounding Ambient AI Scribing.
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The post The Compliance Gap in Ambient AI Scribing and Informed Consent appeared first on Terry Fletcher Consulting, Inc..
The 2026 updates introduced new and revised PCI CPT codes, and even experienced coders are feeling the impact. With fresh code options and shifting applications, accurately capturing Coronary Intervention services—and protecting revenue—has become more challenging.
In this episode, Terry breaks down what’s changed, how to navigate the nuances, and what you need to know about bundling rules to stay compliant and confident.
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The post Cardiology PCI Coding Made Clear appeared first on Terry Fletcher Consulting, Inc..
OpenAI’s launch of ChatGPT Health is reigniting a familiar debate about patient‑facing AI — how much it can empower people to access medical information, and how much it might amplify misinformation, anxiety, or privacy risks.
ChatGPT Health allows users to securely enter personal health information and use ChatGPT’s AI to better understand and manage their health concerns. Physicians note, however, that its impact on care will depend heavily on guardrails around accuracy, transparency, and how patients use the tool between visits.
In this episode, Terry breaks down the pros and cons of AI in healthcare and highlights what providers should be cautious about as these tools become more common.
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The post The Pros and Cons of ChatGPT for Healthcare appeared first on Terry Fletcher Consulting, Inc..
Time-based coding can be a powerful, defensible approach for E/M services—when it’s documented the right way. But vague or incomplete time notes can open the door to denials, audits, and compliance problems.
In this episode, Terry breaks down the exact language, documentation elements, and inclusions you need to make time-based E/M coding hold up. She also covers Care Management Services, their time requirements, and how to avoid overlapping time pitfalls. Tune in for a clear, practical walkthrough.
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The post Time Based EM and Care Management Compliance appeared first on Terry Fletcher Consulting, Inc..
Telehealth isn’t going anywhere, but many practices still don’t have a solid audit plan in place. With Medicare’s proposed rules now finalized for 2026—and the added uncertainty of another potential government shutdown—it’s easy to see why compliance teams are feeling the pressure.
In this episode, Terry breaks down five practical tips to help you strengthen or update your telehealth audit plan, especially if you’re providing office visits via telehealth through January 30, 2026. We also highlight insights from Sonal Patel and her excellent NAMAS article on this very topic.
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The post Telehealth Compliance Tips for 2026 appeared first on Terry Fletcher Consulting, Inc..
Terry kicks off 2026 by clearing up a major misunderstanding in the provider and manufacturer community. Some believed that CMS’s last‑minute withdrawal of the LCD for skin substitute products would delay or stop the 2026 reimbursement changes.
That’s not the case. The LCD withdrawal has no impact on the Final Rule, and the new 2026 reimbursement methodology for skin substitutes will move forward exactly as finalized, using an incident‑to payment structure.
In this episode, Terry breaks down the difference between the policy halt and the reimbursement rules, and explains what providers need to know about the updated approach to skin substitutes and skin graft products and services.
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The post Skin Substitutes and Grafts LCD vs Reimbursement 2026 appeared first on Terry Fletcher Consulting, Inc..
Terry closes out the year with a deep dive into Medicare’s newly permanent “Virtual Supervision” rule taking effect in 2026, along with a refresher on the current requirements for reporting services under a physician’s NPI versus an NPP’s NPI.
She urges listeners to approach this shift carefully, outlining the risks tied to non‑compliance, malpractice exposure, and whether patient‑safety concerns outweigh any potential financial upside. Tune in to get the context you need before jumping into this virtual model.
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The post Is Virtual Supervision a Good Idea for 2026? appeared first on Terry Fletcher Consulting, Inc..
2026 is coming in fast, and with it comes a fresh wave of CPT code changes that every healthcare professional needs to be ready for.
On today’s episode of the CodeCast podcast, we break down the newest updates impacting Cardiology, Peripheral Vascular services, and several other key specialties.
From what’s changing to why it matters, we’ll walk through the revisions, additions, and potential pitfalls so you can stay compliant and ahead of the curve as the new year approaches.
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The post 2026 CPT Code Changes Are Coming Fast appeared first on Terry Fletcher Consulting, Inc..
Auditing split/shared encounters can become confusing when providers, auditors, and coders are not aligned. CPT and CMS have both issued guidance to help clarify how these services should be billed.
In this episode of the CodeCast podcast, Terry breaks down where to begin when auditing and educating on Split/Shared visits, what payers are currently saying, and how to maintain compliance for physicians and NPPs to prevent payer audits or confidently address them when they occur.
She also gives a shout out to Sonda Kunzi, CPC, for her NAMAS article referenced during the discussion.
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The post Audit Tips For Split/Shared Visits appeared first on Terry Fletcher Consulting, Inc..
When auditing risk of management in an E/M note, how are over-the-counter (OTC) medications scored? Under the 1995/1997 guidelines, they were categorized in the “low” risk row. However, the 2021 guidelines provide no examples under minimal or low risk, relying instead on AMA and Medicare guidance. Terry explains this distinction and highlights the difference between an acute uncomplicated illness and an acute illness with systemic symptoms. Take a listen.
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The post “Risk” E/M Element OTC Medications appeared first on Terry Fletcher Consulting, Inc..
Medical record signatures are more than the macro “electronically signed by Dr. Jack Jones.” A provider’s signature is a legal attestation that the physician or provider performed, reviewed, and/or agreed with the documentation. Is this actually true, or are your EMR auto-signatures taking over?
Terry discusses this critical aspect of medical record documentation compliance, with a shout-out to NAMAS for an article that also addresses the topic. Plus, a bonus update on the G0136 add-on code for 2026.
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The post MR Signature Compliance appeared first on Terry Fletcher Consulting, Inc..
Across the country, commercial payers are quietly down-coding E/M services without issuing ADRs and without providing notice. Office visit reimbursements are being arbitrarily reduced based on payer algorithms rather than a proper review of documentation for compliance.
In today’s CodeCast episode, Terry sheds light on this growing problem and explains how to take proactive steps to not only challenge it but also prepare for it.
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The post Watch for Payer Automatic Down-Coding Without Notice appeared first on Terry Fletcher Consulting, Inc..
When auditing a medical record, a common mistake is viewing it solely from a coding perspective rather than an auditing perspective. True auditing requires examining not just the encounter itself, but also what occurred before, after, and around it.
Focusing only on coding can result in missed compliance elements and insufficient support for what was—or will be—billed, potentially triggering a formal payer audit.
Terry breaks this all down in today’s episode of the CodeCast podcast.
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The post Auditing a record isn’t the same as coding it appeared first on Terry Fletcher Consulting, Inc..
The September 2025 issue of CPT® Assistant raised important questions about how to appropriately level an evaluation and management (E/M) encounter when the presenting problem is an acute, uncomplicated illness or injury. A growing number of providers have been assigning Level 4 codes simply because an antibiotic was prescribed.
However, this approach may not be accurate when considering the full scope of the encounter and its required documentation elements.
Terry examines this trend and explains why many payers have responded by implementing automatic down-coding policies to address potential overcoding.
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The post Leveling a Visit for an Acute Uncomplicated Illness appeared first on Terry Fletcher Consulting, Inc..
Medical billing and coding encompasses a wide range of responsibilities—from patient registration and claim reimbursement to final payment delivery to the provider. Navigating this process requires close collaboration among billers, coders, insurance companies, patients, and various healthcare professionals.
Although often grouped together as a single discipline, billing and coding are distinct roles that work in tandem to support the healthcare revenue cycle. If you’re considering a career in medical billing and coding, it’s essential to understand that these are separate professions, each demanding unique skills and personality traits. Terry breaks down the individual roles and how they work together to keep the system running smoothly.
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The post Claim Denials: Coding Mistake or Billing Oversight? appeared first on Terry Fletcher Consulting, Inc..
As more practices begin offering screening services, questions around billing for Medicare-specific G codes are becoming more common. In this episode, Terry breaks down when it’s appropriate to bill for preventive services, which providers are eligible, and what requirements must be met.
To bill G codes, providers must be enrolled as Medicare suppliers and follow specific program rules. Eligibility varies by service type—some require enrollment in specialized programs like the Medicare Diabetes Prevention Program (MDPP). For instance, pharmacists can only bill for certain services if certified as DSMT practitioners.
Tune in for real-world examples and expert guidance on navigating preventive service billing.
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The post Understanding Who Can Bill Preventive G Codes appeared first on Terry Fletcher Consulting, Inc..
CMS has updated its stance on Medicare payments during the federal shutdown, confirming that only certain claims will be held—reversing earlier guidance that hinted at a wider pause. But what does this mean for Telehealth and other temporary policies that expired on October 1?
Terry breaks down the latest developments, what’s at risk, and what steps to take next on today’s CodeCast Podcast.
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The post What the Shutdown Means for Medicare and Telehealth appeared first on Terry Fletcher Consulting, Inc..
In this episode, Terry tackles a common pitfall in coding and CDI workflows: skipping straight to the Assessment and Plan (A/P) section of an E/M note to determine service level. Are you overlooking key documentation that could support medical decision-making, risk, or time?
She also calls out a frequent habit among surgery coders—coding from the report header instead of the full operative detail. What assumptions are being made based on titles alone? What critical elements might be missed or misinterpreted?
Terry breaks down why accuracy isn’t enough. Coders must be diligent, thorough, and intentional in their medical record reviews and extrapolation processes. Lazy shortcuts can lead to compliance issues, missed revenue, and flawed data.
Tune in for practical insights on how to elevate your coding practices and avoid costly oversights.
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The post Tips on Reviewing MRs for Coding Accuracy appeared first on Terry Fletcher Consulting, Inc..
Terry explores the critical role coders and auditors play in holding providers accountable. From reviewing clinical documentation and medical record notes to verifying patient eligibility, addressing cases where minors receive treatment without a parent present, and identifying excessive repeat visits lacking medical necessity, this episode highlights the detailed oversight that ensures provider compliance and quality care.
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The post Coders and Auditors Hold Providers Accountable appeared first on Terry Fletcher Consulting, Inc..
In this episode, Terry breaks down the upcoming Prior Authorization pilot programs launching for Medicare Part B Professional Services on January 1, 2026, and for Ambulatory Surgical Centers starting December 15, 2025. She outlines which medical services will be impacted and what providers need to know as these changes roll out.
Terry also shares the latest updates on Telehealth and explains how to access the educational materials from the September 18th webinar if you missed it.
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The post Medicare’s Prior Auth Pilot: What It Means for You appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast Podcast, Terry addresses a common misconception among medical providers: the belief that simply listing a patient’s medications or repeatedly noting “continue meds” is enough to support a moderate-level evaluation and management visit, such as CPT codes 99214 or 99204. In reality, this documentation alone does not meet the criteria.=
Payers—including MACs, commercial insurers, and Medicaid programs—are increasingly updating their policies to clarify that providers must demonstrate the cognitive effort involved in assessing the risks tied to prescription drug management. Reviewing a medication list without further analysis or context is not sufficient. Instead, documentation should reflect the clinical reasoning, counseling, and risk evaluation discussed with the patient, including potential outcomes related to medication adherence or non-adherence.
Terry breaks down what this means for coding accuracy and compliance, offering insights into how providers can better capture the complexity of prescription drug management in their documentation.
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The post Are you documenting prescription drug management risk? (Fixed Audio) appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast Podcast, Terry addresses a common misconception among medical providers: the belief that simply listing a patient’s medications or repeatedly noting “continue meds” is enough to support a moderate-level evaluation and management visit, such as CPT codes 99214 or 99204. In reality, this documentation alone does not meet the criteria.=
Payers—including MACs, commercial insurers, and Medicaid programs—are increasingly updating their policies to clarify that providers must demonstrate the cognitive effort involved in assessing the risks tied to prescription drug management. Reviewing a medication list without further analysis or context is not sufficient. Instead, documentation should reflect the clinical reasoning, counseling, and risk evaluation discussed with the patient, including potential outcomes related to medication adherence or non-adherence.
Terry breaks down what this means for coding accuracy and compliance, offering insights into how providers can better capture the complexity of prescription drug management in their documentation.
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The post Are you documenting prescription drug management risk? appeared first on Terry Fletcher Consulting, Inc..
A split or shared visit is an evaluation and management (E/M) service performed jointly by a physician and a non-physician practitioner (NPP) from the same group in a facility setting. Under applicable laws and regulations, either the physician or the NPP may bill for the service—provided they deliver it independently. Reimbursement goes to the practitioner who performs the substantive portion of the visit.
However, many practices mistakenly confuse shared visits with “incident to” services, which are fundamentally different. In this episode of the CodeCast podcast, Terry breaks down the distinction and clears up the confusion.
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The post Split/Shared Visits Update appeared first on Terry Fletcher Consulting, Inc..
In this week’s episode of the CodeCast Podcast, Terry Fletcher previews potential Telehealth updates and changes set to take effect on October 1. She also discusses how major surgery can be considered a risk factor in Evaluation and Management coding, and explains the importance of properly sequencing ICD-10-CM codes to ensure reimbursement success.
Listeners are encouraged to check out the latest Telehealth webinar, available now at www.terryfletcher.net.
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The post Telehealth October 2025 Preview appeared first on Terry Fletcher Consulting, Inc..
In this episode of CodeCast, Terry takes a closer look at the growing issue of undercoding in healthcare. Often misunderstood or overlooked, undercoding involves reporting fewer services than were actually provided, assigning a lower-level code than warranted, or inaccurately documenting patient encounters.
While some may view it as a conservative approach to avoid audits or reduce patient costs, under-coding can lead to serious consequences—including reduced reimbursement, skewed provider data, and potential compliance violations.
Terry breaks down how this practice is being viewed in today’s regulatory landscape and what it means for coders, providers, and healthcare organizations.
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The post Undercoding Is Real—And It’s Costing You appeared first on Terry Fletcher Consulting, Inc..
In this episode of CodeCast, Terry dives into the complexities of billing bilateral procedures and the growing tension between Medicare guidelines and commercial payer policies. Modifier 50 is used to report procedures performed on both sides of the body during the same operative session. When billed correctly, the procedure should appear on a single claim line with the CPT or HCPCS code, modifier 50, and one unit of service. Depending on the procedure’s bilateral indicator, Medicare may apply a 150% payment adjustment.
However, commercial payers are increasingly rejecting this standard. Many are now reimbursing only one line item, effectively ignoring the bilateral nature of the procedure. This shift poses serious risks to patient care. Providers may be forced to schedule a second surgery, exposing patients to additional anesthesia and delaying medically necessary treatment.
Terry breaks down the implications of these policy changes and offers strategies for providers to advocate for proper reimbursement. Tune in to learn how to protect your patients and your practice from the fallout of this troubling trend.
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The post Bilateral Billing Under Fire: Modifier 50 appeared first on Terry Fletcher Consulting, Inc..
Medicare has designated two HCPCS codes for women’s screening services:
- G0101 – Screening pelvic and clinical breast exam
- Q0091 – Collection of a screening Pap smear
These codes are reimbursable every two years, but they’re not considered comprehensive preventive medicine services. In this episode, Terry breaks down how these screenings fit into the broader billing landscape — including whether they can be reported on the same date as:
- Preventive care codes
- Annual Wellness Visits (AWVs)
- Evaluation and Management (E/M) services
If you’ve ever wondered how to navigate these overlapping services without triggering denials or confusion, this one’s for you. Tune in for practical tips and coding clarity.
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The post G0101 and Preventative Billing appeared first on Terry Fletcher Consulting, Inc..
In this episode, Terry dives into the latest findings from the Centers for Medicare & Medicaid Services (CMS) regarding Evaluation and Management (E/M) services. According to the 2023 CERT (Comprehensive Error Rate Testing) data:
- Insufficient documentation led to 34% of improper payments
- No documentation accounted for 7.5%
- Incorrect coding was responsible for a staggering 52.4%
- Other errors made up the remaining 6.1%
Terry breaks down what these numbers mean for your practice and shares actionable strategies to reduce denials and improve compliance.
For more details, visit: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/medicare-provider-compliance-tips/medicare-provider-compliance-tips.html#OtherErrors
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The post CMS E/M Improper Payment Report appeared first on Terry Fletcher Consulting, Inc..
The FY 2026 ICD-10-CM Official Guidelines are out. In this episode, Terry breaks down the key updates and what they mean for your coding workflow. Tune in as she covers:
- New considerations for diagnosis coding in heart disease, HIV, and diabetes
- How to apply the latest guidance across multiple specialties
- A closer look at inpatient discharge codes 99238 and 99239—are you using them compliantly?
Whether you’re a seasoned coder or just brushing up for the new fiscal year, this episode is packed with practical insights to keep you accurate and audit-ready.
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- Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627
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The post ICD-10-CM Official Guidelines for FY 2026 appeared first on Terry Fletcher Consulting, Inc..
Join Terry on the latest CodeCast podcast as she tackles your most pressing medical coding and compliance questions in our “Top Ten Tuesday” segment!
Terry clears up common misunderstandings and provides clarity on complex ICD-10-CM coding scenarios. Get expert tips to improve your diagnostic coding accuracy. She also discusses how navigating the nuances of telehealth billing can be tricky. We’ll demystify the Primary Care Exception and offer essential guidance for telehealth services compliance.
Plus, that persistent G2211 add-on code is back! Terry breaks down its proper application and helps you avoid common errors, ensuring you’re using this evaluation and management (E/M) add-on code correctly.
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The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..
In this essential episode, we dive deep into the heightened scrutiny surrounding split/shared visits, particularly high-level 99223 initial hospital visits.
Join Terry as she breaks down the latest payer audits impacting these services. We’ll explore critical compliance issues and offer actionable strategies to help your providers and practices proactively protect themselves from unwanted scrutiny and audit risk.
Don’t let coding complexities expose your practice. Whether you’re a medical coder, healthcare provider, or practice manager, this episode provides the vital information you need to confidently navigate split/shared visit guidelines and maintain audit readiness.
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The post Navigating Split/Shared Visit Audit Risks appeared first on Terry Fletcher Consulting, Inc..
Determining whether HCPCS code G2211 can be billed when a patient sees a different physician or practitioner within the same group practice, even colleagues in the same specialty, presents an interesting coding challenge. The key consideration revolves around whether the new provider serves as the “continuing focal point for all needed services or provides ongoing care for that complex or serious single condition.”
Expert analysis by specialists like Terry is crucial in breaking down these nuances to ensure accurate coding for the G2211 complexity add-on. The code’s intent is to recognize the inherent complexity of visits that are part of a longitudinal patient-provider relationship, either where the practitioner is the primary point of contact for all healthcare needs, or where they manage a single, serious, or complex condition over time.
When a patient transitions to a new provider within the same group, even in the same specialty, the question arises whether the new provider has established or intends to establish the same level of consistent, ongoing care that would justify billing G2211. This requires careful consideration of the documentation and the nature of the relationship being built with the new practitioner.
Terry, our coding expert, unpacks these nuances to help you avoid over or under-coding. Tune in to ensure your practice is accurately capturing the true complexity of patient care!
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The post Revisiting G2211 with a Change of Provider appeared first on Terry Fletcher Consulting, Inc..
In today’s episode of the CodeCast podcast, Terry untangles the complexities of Protected Health Information (PHI) and HIPAA as they relate to workers’ compensation cases. She’ll clarify the rights of both patients and employers when requests for PHI reach a healthcare provider’s office.
This can be a tricky area, especially given potential state-specific regulations. This episode could be an invaluable resource for navigating these complicated scenarios.
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- Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627
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The post HIPAA and Workers Comp Patients appeared first on Terry Fletcher Consulting, Inc..
A question I’m often asked is, “Why do physicians charge so much?” There’s no easy answer, as there isn’t a fixed price list for medical services. Due to the healthcare system’s complexity and the absence of set prices, providers are largely free to charge what the market will bear.
However, can there be consequences for over-pricing or egregiously overcharging payers? Yes. It’s crucial to pay close attention to this issue, as it could lead to trouble not only legally but also in terms of regulatory compliance.
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The post Can physicians charge whatever they want to Insurance Payers? appeared first on Terry Fletcher Consulting, Inc..
Engaging with “bad actors” in medical billing can have serious consequences for both patients and healthcare providers. More and more providers are engaging without checking. Here’s what could happen. Terry discusses it all with examples.
- Legal repercussions: Providers can face hefty fines, civil or criminal charges, and even loss of their medical license for engaging in fraudulent billing.
- Financial impact: Audits, penalties, and required repayments can lead to significant financial losses for the provider’s practice.
- Reputational damage: Being associated with fraud can significantly damage a provider’s reputation, leading to decreased patient volume and referral issues.
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The post Watch out for “bad actors” on billing advice appeared first on Terry Fletcher Consulting, Inc..
In this episode, Terry challenges all medical professionals. What is your role in managing the patient experience?
A lack of patient prep can lead to an incomplete encounter for the physician including excessive visits. It can also lead to leakage in all departments, including the RCM staff’s ability to perform their job.
Terry offers her tips for accountability in all departments, starting with scheduling, to ensure the provider is “prepared” to see the patient.
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The post Is the provider “prepared” to see the patient? appeared first on Terry Fletcher Consulting, Inc..
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 to delayed payments, operational burdens, and strained resources.
In this episode of the CodeCast Podcast, Terry runs through how the NSA works not only for your RCM staff but also how she dealt with a personal “balance bill” for the win!
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The post No Surprises Act and OON Claims appeared first on Terry Fletcher Consulting, Inc..
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 investigational services that are considered not medically necessary or a covered benefit under most payers. Terry discusses the ins and outs of this practices and how to make sure you are not falling into a false claim trap.
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The post Medicare Rules For Experimental or Investigational Services appeared first on Terry Fletcher Consulting, Inc..
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.
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The post Behavioral Health Coding and Documentation appeared first on Terry Fletcher Consulting, Inc..
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 world of technology.
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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 covers the reality of this change and what an independent interpretation means, so that you are not upcoding based on assumptions.
Subscribe and ListenYou can subscribe to our podcasts via:
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The post Can you get credit for ordering and interpretation of a test? appeared first on Terry Fletcher Consulting, Inc..
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 understanding that medical services reported should meet documentation standards for level selection. Those standards should also appropriately indicate why the patient is visiting the provider, based on the presenting problems.
This episode of the CodeCast echoes Terry’s insights that auditors, coders, and medical professionals focus on medical necessity first, then look to coding.
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The post Medical Necessity Comes Before Coding appeared first on Terry Fletcher Consulting, Inc..
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 information covered on this week’s show.
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The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..
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 the patient. The CPT lists different levels of E and M services for both new and established patients and describes services that are included as E/M services. Such activities include obtaining, reviewing, and analyzing appropriate diagnostic tests.”
Tune in to this episode for an in-depth discussion as Terry details trying to report a telehealth visit for giving test results may be considered double-dipping: and can get you into hot water!
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The post Giving Tests Results to Patients… Where’s the Payment? appeared first on Terry Fletcher Consulting, Inc..
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 deadlines typically associated with them.
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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 their encounter. Listen to this episode for all of the details.
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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.
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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 in this process.
Terry shares her thoughts on what makes a coder valuable, even if they are less visible than the providers.
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The post The Crucial Role of the Coder in Quality Patient Care appeared first on Terry Fletcher Consulting, Inc..
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.
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The post ICD-10-CM April 1st Updates appeared first on Terry Fletcher Consulting, Inc..
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 for the latter procedure is not updated.
Terry covers all the issues with denials that can be avoided with a careful step back.
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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.
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The post Acute Uncomplicated vs. Acute Complicated E/M Auditing appeared first on Terry Fletcher Consulting, Inc..
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!
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The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..
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 technical components, meaning you are billing for the test ordered. In that case, you can’t double dip or get additional credit for the order, the review, or a professional interpretation.
You can get credit for ordering a test and for an independent interpretation, as long as your documentation meets the criteria for what an independent interpretation is.
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The post Independent Interpretations of E/M Data Points appeared first on Terry Fletcher Consulting, Inc..
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, often confuse even veteran coders.
Terry uncovers the truth about four aspects of these edits to ensure you’re not letting MUEs wreak havoc on your practice’s coding and reimbursement efforts.
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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 problems addressed and for the management and treatment for the patient.
Terry discusses the difference and how to make sure you don’t over or under-code in the process.
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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 implement to ensure compliance and have good compliance. The NSA can also make things tricky, but Terry clears up what you can and cannot do with professional courtesy.
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The post Professional Courtesy appeared first on Terry Fletcher Consulting, Inc..
The Electronic Medical Record (EMR) has many benefits over handwritten entries in a paper chart. EMR entries are always legible, dated, and timed. Patient information can be available at the point of care and remotely.
Some EMR systems include computerized physician order entry and decision-support tools to improve patient care and safety. However, recent audits reflect that CDI can be compromised when copy-paste or pull-forward information is not updated or reviewed.
Terry discusses the importance of the medical record’s integrity and ensuring your providers listen.
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The post EMR Clinical Documentation Integrity appeared first on Terry Fletcher Consulting, Inc..
There’s a lot of confusion – and conjecture – on what to do about audio-only Telehealth while the new CMS and HHS administrations settle in under a new President in 2025.
The final rule, the federal register, and the last CR made things more vague for this transition.
In this episode Terry attempts to clear up these issues, giving you her best practices to remain compliant until further notice.
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The post Audio-Only Telehealth in 2025 appeared first on Terry Fletcher Consulting, Inc..
When auditing Annual Wellness Visits (AWV), is the concept still the same as preventive exams concerning modifier 25?
The AWV does not include managing medications or managing conditions. However, the rules need to see medical necessity for the E/M on the same date with a -25 modifier. Remember, patients do not have a share of cost of AWV’s so if you add an E/M it comes out of their pocket too.
Terry also adds more commentary for the audio-only Telehealth rules for 2025.
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The post AWV and Medical Necessity Extras appeared first on Terry Fletcher Consulting, Inc..
This New Year’s Eve episode of the Top 10 Tuesday Q&A includes E/M Data questions, assistants at surgery, colon screenings, Telehealth extensions, and prescription drug management questions.
It’s an episode you don’t want to miss. Happy New Year Everyone!
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The post Top 10 Tuesday Q&A – Happy New Year Edition appeared first on Terry Fletcher Consulting, Inc..
In the final hour, Congress passed the American Relief Act. Telehealth was addressed and the geographical location was extended through March 2025.
Terry give us the details from this HR bill in this short but sweet episode so you can enjoy your Christmas holiday.
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The post Did We Get a Congressional Telehealth Gift for Christmas? appeared first on Terry Fletcher Consulting, Inc..
E/M Coding still has confusion when capturing “data points” elements. When deciding to give credit for either an independent interpretation (CAT 2) or a review of test results (CAT 1) is an often misunderstood component of the Medical Decision Making (MDM) table.
Proper documentation of independent interpretation is required to impact the MDM, and consequently, reimbursement.
Terry breaks down the compliance issues and best practices to make sure you are not over-coding. (Also, a shout out to Shannon DeConda and her excellent article on the topic on the NAMAS blog.)
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The post Data Point – Review of Test or Independent Interpretation? appeared first on Terry Fletcher Consulting, Inc..
The 2025 CPT® codes will impact billing and coding across various specialties. The annual CPT® updates include new, revised, and deleted codes and coding guidelines effective Jan 1st, 2025.
CPT® 2025 includes 270 new codes, 112 revised codes, and 49 deleted codes. There are no code changes for anesthesia, respiratory, or auditory services. The most significant changes are to telemedicine evaluation and management (E/M) services, skin substitutes, laboratory and pathology services, and Category III codes.
Terry overviews the changes by section in today’s CodeCast Podcast.
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The post CPT 2025 Looksee appeared first on Terry Fletcher Consulting, Inc..
Becoming a certified medical coder can be very exciting but also disheartening if you thought a job in coding would magically appear once you got your certification.
In this episode of the CodeCast podcast, Terry discusses studying and test-taking tips for your certification, common misconceptions of job opportunities, and what it takes to persevere for a career in Coding or the Business in Medicine. Shout out to AAPC member LeAndrea Mack and her article in the October 2024 issue of AAPC Magazine on this topic as well.
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The post Coding Career Opportunities and Challenges appeared first on Terry Fletcher Consulting, Inc..
Terry makes it quick and to the point in this Thanksgiving Day episode of the CodeCast Podcast.
Terry gives you a fun list of ICD-10-CM related to our beloved family and friends’ holiday.
Be safe and careful out there this holiday weekend: and enjoy!
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The post Thanksgiving ICD-10-CM: Be Safe and Thankful! appeared first on Terry Fletcher Consulting, Inc..
Terry is back with another Top Ten Tuesday discussion.
In this episode, she discusses front desk to billing office workflow mistakes, looking at patient demographics, insurance information, HMO referrals, PA’s, and data backups.
Tune in to reset your RCM workflows.
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The post Top 10 Tuesday Q&A – RCM Workflow Mistakes appeared first on Terry Fletcher Consulting, Inc..
Today on the CodeCast podcast, Terry discusses best practices for the -25 Modifier, where to find her latest blog on the AAPC website, and what the MAHA (Make America Healthy Again) movement means to our country.
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The post The 25 Modifier and More appeared first on Terry Fletcher Consulting, Inc..
CMS published the 2025 Final Rule on November 1st. Terry breaks down the highlights and gives you the facts on the Telehealth “mess” that could have 85% of Medicare patients without access to virtual care.
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The post CMS final rule is out and Telehealth is an issue appeared first on Terry Fletcher Consulting, Inc..
Many practices have engaged in coding for TCM (Transitional Care Management) services but are finding that they are receiving more denials than payments.
Terry breaks down why that is, and sheds light on what is needed to qualify billing for these services.
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The post Why are TCM services receiving more denials than payments? appeared first on Terry Fletcher Consulting, Inc..
Artificial intelligence (AI) has the potential to make substantial progress toward the goal of making healthcare more personalized, predictive, preventative, and interactive.
However, AI-based systems raise concerns regarding data security and privacy. Because health records are important and vulnerable, hackers often target them during data breaches. The absence of standard guidelines for the moral use of AI and ML (machine learning) in healthcare has only worsened the situation.
There is debate about how far artificial intelligence (AI) may be utilized ethically in healthcare settings since there are no universal guidelines for its use. Therefore, maintaining the confidentiality of medical records is crucial.
Terry scratches the surface and discusses some concerns about AI in healthcare predictive models and what to also look for as we continue to use AI scribes.
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The post AI in Medical Coding: What’s the Reality? appeared first on Terry Fletcher Consulting, Inc..
HIPAA has many privacy issues that most practices have in their HIPAA compliance manuals. However, current HIPAA violations are coming to light when employees purposefully search patient PHI for personal use or curiosity. This is not only a violation of privacy laws but could have a cascading effect if not stopped in its tracks.
In this episode, Terry discusses these issues at length and what safeguards to take in this political climate.
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The post HIPAA violations your organizations should avoid appeared first on Terry Fletcher Consulting, Inc..
In this edition of the CodeCast podcast, Terry discusses the “subtle changes” to look for in the ICD-10-CM updates effective October 1st.
Also, Terry clears up understanding the UHC Gold Card Program, and what CMS looks at when they send you a denial.
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The post RCM Updates for 4th Quarter appeared first on Terry Fletcher Consulting, Inc..
According to the AMA, most physicians lack training in “webside manner.” Researchers from the University of Michigan Medical School and the Veterans Affairs Ann Arbor Healthcare System surveyed 1,213 patients from their respective institutions to measure preferences regarding the visual background seen during a video visit.
Today’s CodeCast podcast brings you the survey results, with some surprising details. Also, Terry gives her insights on how to prepare for virtual visits.
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The post Telemedicine “Webside Manner” appeared first on Terry Fletcher Consulting, Inc..
Many practices offer cash payment options to avoid insurance billing, hoping to reduce administrative burden or boost revenue.
However, this practice of charging cash for services that could be billed to and covered by a patient’s insurance plan raises serious compliance concerns. Federal law and insurance contracts generally prohibit this practice because it undermines the healthcare payment system and can lead to regulatory violations.
Terry discusses the compliance ramifications of this policy with a little health from a NAMAS article.
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The post Charging patients cash for “insurance covered” services appeared first on Terry Fletcher Consulting, Inc..
Sometimes there are coding, compliance, and billing questions that we struggle to find answers to in any published guidance or specific regulatory rules.
This week on the CodeCast podcast, Terry brings up three specific questions that we are always hunting for answers to and the best way to deal with them.
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The post Sometimes the rules are as “clear as mud” appeared first on Terry Fletcher Consulting, Inc..
In this episode Terry discusses the importance of ICD-10-CM codes on billing claims. She also clarifies the ICD-10-CM General Guidelines on Borderline Diagnoses, Laterality, Acute versus Chronic Conditions, and when to leave the symptoms off the claim for definitive diagnoses.
Listen in for this important information capture.
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The post Does ICD-10-CM Codes Claim Position Matter? appeared first on Terry Fletcher Consulting, Inc..
CMS released their FAQ sheet for the add-on code HCPCS G2211, to office visits. The sheet clarifies where denials and grey areas for reporting.
Tune in as Terry goes over twelve FAQs from CMS along with her commentary to best practices for this complexity add-on.
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The post G2211 CMS FAQ Sheet Released appeared first on Terry Fletcher Consulting, Inc..
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.
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The post NCCI Updates 30.2 and No Show Appointments appeared first on Terry Fletcher Consulting, Inc..
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 qualify? Terry covers the details on documentation requirements (on CPT page 55) and its importance for compliance.
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- Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627
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The post Principle Care Management (PCM) appeared first on Terry Fletcher Consulting, Inc..
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 are due to incorrectly entered or missing information. When a clinic is unable to bill the insurance company properly, a rejected claim or frequent denials can put you in a position to provide an unexpected bill to the patient.
Too much confusion around the billing process can discourage patients from visiting your clinic or, much worse, make them put off necessary treatments.
In this episode, Terry discusses the top ten coding and billing mistakes and how to lessen those errors for successful claim submission.
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The post Top 10 Coding and Billing Mistakes – Let’s Fix It! appeared first on Terry Fletcher Consulting, Inc..
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 patients need to also be involved in these discussions.
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The post Trigger Point Injections and LCDs appeared first on Terry Fletcher Consulting, Inc..
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 between the two roles!
Terry discusses that intersect today in her 346th episode of the CodeCast podcast.
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The post Are you a Coder or a Biller? appeared first on Terry Fletcher Consulting, Inc..
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 particular procedure.
When used appropriately, modifier 22 reimburses the physician for unforeseen difficulties or additional time spent that are not usually anticipated for the procedure. However, as most coding staff know, it takes some savvy coding and insight for proper reimbursement, and will take more than simply attaching a modifier to a service code if your provider is to be compensated accordingly. Terry discusses how to be successful when using the 22 modifier.
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The post When To Use The -22 Modifier appeared first on Terry Fletcher Consulting, Inc..
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 evades the responsibility, and compliance, of documentation.
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The post Is a Medical Record “Errors Disclaimer” Valid? appeared first on Terry Fletcher Consulting, Inc..
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 issues with this encounter. Join us.
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The post Urgent Care to ER Coding appeared first on Terry Fletcher Consulting, Inc..
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.
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The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..
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 more in our latest episode.
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The post Coding Hernia Repairs in 2024 appeared first on Terry Fletcher Consulting, Inc..
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, and what details to pay attention to.
As a bonus, the coding question of the day relates to PV procedures.
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The post What does “separate procedure” mean in CPT? appeared first on Terry Fletcher Consulting, Inc..
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 level of service billed, but also that the visit is even medically necessary to be able to be billed.
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The post Is This Really Medically Necessary? appeared first on Terry Fletcher Consulting, Inc..
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 to use this code, but now after a quarter of usage, let’s look at the “when” to report it.
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The post Revisiting SDoH G0136 Reporting appeared first on Terry Fletcher Consulting, Inc..
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 internal audits find any irregularities: and Terry Fletcher Consulting, Inc. is here to help if you need us!
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The post Top 10 Tuesday Q&A – Auditing Telehealth appeared first on Terry Fletcher Consulting, Inc..
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 of state laws, and providers forgetting to report when this relationship ends, the physician may still listed as their supervising physician.
Terry uncovers these issues that cost physicians not only money, but possibly their license to practice.
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The post Compliance Issues With MD/QHP Collaboration Agreements appeared first on Terry Fletcher Consulting, Inc..
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 Health, LLC.
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The post Critical Care Inclusions and Carve-Outs appeared first on Terry Fletcher Consulting, Inc..
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 talk to the provider alone on treatment options or mortality issues, or pediatric patients where the conversation may be too sensitive to have the child present. But what can you bill for?
Terry covers this controversial topic in this edition of the CodeCast podcast.
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The post Can you bill an E/M service when the patient isn’t present? appeared first on Terry Fletcher Consulting, Inc..
When a Medicare beneficiary arrives at a hospital in need of medical or surgical care, the physician or other qualified practitioner must decide whether to admit the beneficiary as an inpatient or treat him or her as an outpatient.
These decisions have significant implications for hospital payment and beneficiary cost sharing. Not all care provided in a hospital setting is appropriate for inpatient, Part A payment.
Terry discusses the 2-midnight rule, and how that impacts both Part A and Part B providers and patients. There is more to consider than meets the eye.
Terry also covers what CMS recently published in the Final Rule for MA plans.
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The post 2-Midnight Rule and MA plans appeared first on Terry Fletcher Consulting, Inc..
In this week’s episode of the CodeCast podcast Terry discusses collecting information on medical practice websites.
How you collect data on a website is equally as important as the data itself. If a patient doesn’t mention a medical condition, their information may still be considered as PHI.
Terry covers requirements, such as PHE and ePHI access, securing data in an encrypted manner or HIPAA-compliant location, and having a system in place to destroy sensitive data that is no longer needed.
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The post Did you know this is a HIPAA violation? appeared first on Terry Fletcher Consulting, Inc..
Terry discusses how to be accurate in your documentation when picking the low, moderate or high element(s) of MDM.
When listing “problems addressed” in your E/M record, and considering chronic conditions, the definition of a stable, chronic illness, per AMA/CPT states, “stable” to categorize MDM as defined by the specific treatment goals for an individual patient.
A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function. By this definition, a patient might be living with a chronic condition that is controlled.
However, if they are falling short of their treatment goals, they would not be considered “stable.”
This shows that the spirit of the new AMA/CPT E/M Documentation rules are about patient-centered care and that every patient has a unique set of goals and circumstances: achieving these personalized objectives truly determines “stability.”
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The post E/M Services: Stable or Unstable Chronic Conditions? appeared first on Terry Fletcher Consulting, Inc..
CPT says: “If no specific CPT or HCPCS code exists, then the procedure must be reported using an appropriate unlisted CPT code.”
Unlisted CPT codes, when reported with appropriate documentation, should be reimbursed. It is the responsibility of the surgeon, and the coding or billing staff, to report unlisted CPT codes and follow up with payors if a claim is denied.
On this episode of the CodeCast Podcast, Terry Fletcher will dive into this topic to help you with successful unlisted procedure claims.
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The post Coding and Billing The “Unlisted Code” appeared first on Terry Fletcher Consulting, Inc..
Join Terry Fletcher on this week’s CodeCast as her Top 10 Tuesday returns. Terry has a packed podcast as she answers questions about G2211, 99459, and new versus established patients.
This is one episode you don’t want to miss for insights and resources to your most important coding, billing, and compliance questions.
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The post Top 10 Tuesday Q&A – Coding, Billing and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..
Did you know there are CPT codes for online digital E/M services? CPT codes 99421-99423 are for use by physicians, physician assistants, and advanced practice nurse practitioners performing brief online E/M services via a secure platform. (Like a patient portal.)
What is required to bill for these services? Consent? Interactive Conversation? Modifiers? POS? And what is CBTS?
Tune in as Terry discusses this topic, and more, to find out if this revenue opportunity and patient value-added service is something you should report.
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The post Reporting eVisits 99421-99423 appeared first on Terry Fletcher Consulting, Inc..
We have received questions left and right regarding the new Medicare add-on code +G2211 – for complexity and serious condition provider/patient long-term relationship care.
We discussed this code in September 2023, when it was a CMS proposal, but now that it is effective let’s look at the realities. The Modifier -25, when reported on an E/M claim with the G2211 will be denied.
But what about the NCCI edits when you can’t avoid the 25 modifier, such as adding, immunizations or preventative services? Will you still see denials of the G2211? Can NPP’s report this add-on? What conditions can be considered? What providers and specialties can report this code?
Tune in this week as Terry provides some answers to these questions and more.
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The post Revisiting the G2211 in 2024 appeared first on Terry Fletcher Consulting, Inc..
This episode of the CodeCast is sponsored by DecisionHealth LLC, Part B News.
The PHE, public health emergency, ended on May 11th, 2023. However, the confusion on reporting Telehealth services continues. It is imperative to be up-to-date on all of the current published guidance.
In this episode, Terry shares her Telehealth services tips and checklist that will help you stay compliant (primarily for Medicare) in 2024. Terry discusses changes that will impact all medical practices engaged in using Telehealth for many of their office visit and hospital visit encounters.
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The post 2024 Telehealth Checklist appeared first on Terry Fletcher Consulting, Inc..
CORRECTED AUDIO
The generative artificial intelligence (also known as “AI”) boom is in full swing now. Terry has been researching AI in healthcare: some people are thrilled with it, while others are not.
Is scraping the web for training data ethical? Who decides whether AI documentation and “expertise” is any good? How should copyright law apply to AI-generated work? Where is the oversight to deter biases and hallucinations?
In this episode, Terry illustrates the resistance to using AI and asks tough questions to advocate for safeguards to make sure technological progress doesn’t destroy the healthcare industry. Everyone needs to understand what’s at stake, other than a future envisioned by Big Tech.
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The post Concerns About AI in Healthcare for 2024 appeared first on Terry Fletcher Consulting, Inc..
This week on the CodeCast Podcast, Terry explains the new 2024 CPT add-on code +99459 for pelvic exams when assistant clinical staff is needed to help the physician.
Check out today’s episode to make sure you know what the documentation and coding rules are before diving into this situation.
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The post 2024 Pelvic Exam Add-On Code appeared first on Terry Fletcher Consulting, Inc..
A physician, non-physician practitioner (NPP), or clinical psychologist can assess a patient who they suspect may have unmet needs (defined as Social Determinants of Health or SDoH.
In 2024 CMS is adding another G-code for SDoH assessment during an E/M encounter. This is for an assessment: not a screening. This service is not intended to be a screening done on every patient and cannot be performed via a portal exchange.
Tune in this week to learn more about this code, the reimbursement process, and any frequency rules.
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The post When to use the new SDoH add-on code appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast Podcast, Terry Fletcher discusses the seven elements of an effective compliance program. Last month, HHS-OIG outlined and updated this guidance.
With a broad spectrum of healthcare entities, staff, and providers playing a role in healthcare delivery today, this information can be generally applied across the entire healthcare industry or with small and large medical practices alike.
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The post 7 Elements of a Successful Compliance Program via OIG appeared first on Terry Fletcher Consulting, Inc..
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 used on any medical encounter regardless of the reason for the visit. A history of an illness may alter what treatment is ordered for a patient, so it is important information to report. This directly supports the medical necessity of the encounter, which is the overarching criteria to report the outpatient or office visit at all.
Terry breaks it down for us, along with answering a 25-modifier question.
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The post Patient History = Medical Necessity appeared first on Terry Fletcher Consulting, Inc..
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 and criteria.
Terry breaks down the confusion and discusses why this is more of a value-based service than a monetary windfall. Listen to this informative episode for more details.
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The post Transitional Care Management Services appeared first on Terry Fletcher Consulting, Inc..
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 a service can be CPT considered for Telehealth inclusion.
Terry shares this insight, plus her commentary on how to implement it into your updated compliance programs.
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The post Telehealth CPT 2024 Rules appeared first on Terry Fletcher Consulting, Inc..
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 also consider “best practices” and payer-published guidance before you do only the minimum (or what is “technically” correct).
Terry makes this clear distinction in today’s CodeCast Podcast.
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The post E/M Leveling with MDM: Right or Wrong? appeared first on Terry Fletcher Consulting, Inc..
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 billing provider.
Terry breaks down the rules in this episode to ensure misinterpretations do not have providers reporting incorrectly.
Also, Terry takes a look at abdominal aortic coding.
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The post Final Rule 2024 Shared/Split Visit appeared first on Terry Fletcher Consulting, Inc..
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 a Telehealth video visit loses feed?
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The post Top 10 Tuesday Q&A – Halloween Episode appeared first on Terry Fletcher Consulting, Inc..
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 ADR (Additional Documentation Request).
You don’t want to ignore this, but embrace the process and understand that this oversight helps everyone.
Terry breaks it down. Also, some insights on Telehospital expansions assisting rural communities.
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The post CMS clarifies how to respond to a CERT audit appeared first on Terry Fletcher Consulting, Inc..
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 record.
Have you updated the language to fit with the current times?
Terry shares a few examples of issues that can raise red flags during an audit.
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The post Is your CDI compromised by dated EMR entries? appeared first on Terry Fletcher Consulting, Inc..
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 clarification into MNT coding since there continues to be a push to report these codes when the diagnosis is not covered.
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The post A Look ahead to the 2024 CPT codes appeared first on Terry Fletcher Consulting, Inc..
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 determine whether an E/M service justifies the use of modifier 25 according to CPT guidelines, CMS rules, and payer policy language.
Also, this episode’s coding question is a reminder of how to use the TCM rules.
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The post Modifier 25 appeared first on Terry Fletcher Consulting, Inc..
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 MD or DO behind the term, is not only misleading but can jeopardize patient safety, expectations and outcomes.
Terry dives into this controversial topic, stating where the blurred lines are and the importance of staying in our respective lanes.
Also, this episode’s coding question focuses on the new patient visit 99205.
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The post Are you blurring the lines on who’s a doctor or a nurse? appeared first on Terry Fletcher Consulting, Inc..
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 use prior authorization to make sure that a specific medical service is needed and worth the cost, and that no duplicative services are being performed.
Payers use prior authorization as a way to keep healthcare costs in check. Terry discusses the Medicare, Medicare Advantage, and Commercial Plan terms with PAs and how to make it administratively manageable. Also, a coding question on Smoking Cessation.
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The post Understanding Prior Authorization appeared first on Terry Fletcher Consulting, Inc..
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 CodeCast podcast, Terry attempts to bring some clarity into the Data Points discussion, regarding independent interpretations versus reviewed note. Subscribe and Listen You can subscribe […]
The post EM Data Points Confusion Clarifications appeared first on Terry Fletcher Consulting, Inc..
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 patient, in a longitudinal way.
Terry goes over what the Federal Register proposal is, and who cannot consider this code in 2024. There is a lot to unwrap here.
Terry also covers a bonus payer announcement that will impact many contracts. Tune in for these important details!
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The post What is the G2211 complexity add-on for 2024? appeared first on Terry Fletcher Consulting, Inc..
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 codes, how a physician order must be documented, what constitutes critical care coding, and more. Subscribe and Listen You can subscribe to our podcasts via: […]
The post Top 10 Tuesday Q&A – Coding, Billing and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..
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 payor’s perspective, waiving cost‐sharing amounts creates two problems. First, payors often contract with providers to pay based in part on the provider’s usual charges. The […]
The post Waiving Co-Pays and Deductibles appeared first on Terry Fletcher Consulting, Inc..
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 also see denials if you’re not careful. Terry updates some of the latest postings by CMS so that we are all on top of the […]
The post What’s The Latest Medicare Update? appeared first on Terry Fletcher Consulting, Inc..
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 discusses the difference between pre-op visits and pre-op clearances. Is it a visit performed by the surgeon or the surgeon’s QHP? Or a provider not […]
The post Can Pre-Op Visits Be Billed? appeared first on Terry Fletcher Consulting, Inc..
When a dietician or nutritionist sees a patient, their services may not covered for bariatric patients aka obesity. It is a nice option to have, but patients, would most likely, have to pay for it themselves. Medicare is clear that they will pay for an obesity screening, and two behavioral health visits, if qualified, but […]
The post Registered Dietitians and Nutritionist Coding and Billing appeared first on Terry Fletcher Consulting, Inc..
Social Determinates of Health are important secondary diagnoses to help explain a patient’s circumstances when it comes to access to medical care, adherence to medical advice, and environmental factors that could hinder care. However, many practices are reporting these codes without a direct relationship to the problems addressed in the encounter. This week Terry discusses […]
The post Using SDoH (Social Determinates of Health) Correctly appeared first on Terry Fletcher Consulting, Inc..
CMS has not addressed a template for audio-only Telehealth visits. Therefore, Terry offers some best practices for audio-only documentation in order to stand up to and be compliant with payer audits. Terry will also talks about when E/M services are partially complete: is there anything to bill? Subscribe and Listen You can subscribe to our […]
The post Documentation Requirements for Audio-Only Visits appeared first on Terry Fletcher Consulting, Inc..
Terry revisits the rule on reporting specificity in the laterality of a diagnosis, when the physician or QHP only gives us unspecified. What can we do as coders? As a bonus, Terry also updates us on the latest “No Surprises Act” protections. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – […]
The post ICD10CM Revisited on Laterality appeared first on Terry Fletcher Consulting, Inc..
QHPs are often certified and must be licensed. Trying to use clinicians that cannot “independently report services to payers” as QHPs will not only flag you for an audit, but you could find yourself in hot water for false billing practices. Terry offers clear guidelines to steer clear of these issues on this episode of […]
The post Defining a QHP appeared first on Terry Fletcher Consulting, Inc..
On an abbreviated edition of the CodeCast, it's "out with the old and in with the new" as Terry gives some quick tips on updating your outdated EMR template relating to E/M 2023 coding.
The post Revisiting The EMR E/M Template appeared first on Terry Fletcher Consulting, Inc..
This week on the CodeCast podcast, Terry discusses external audits, and what you should be looking for when moving from internal to external audits. What are your objectives? Are they SMEs for your practice? What is the scope you need? It’s time to get some piece of mind in your coding, billing and compliance processes. […]
The post What are you looking for in an audit? appeared first on Terry Fletcher Consulting, Inc..
Many virtual visit options are available to patients when they initiate patient-to-physician contact. The definition seems to be lost in all of the Telehealth visits, so in this week’s CodeCast podcast episode, Terry attempts to clarify that definition and help listeners understand how to document that discussion. PIFU is when a patient initiates an appointment […]
The post Patient Initiated Services: What does it mean? appeared first on Terry Fletcher Consulting, Inc..
Reporting 99211 can bring additional revenue into your practice. Appropriately reporting 99211 services can also improve documentation in a practice.
Terry discusses the qualifiers for the 99211, such as having an established patient, the encounter must be F2F and more. Listen for your tips on how to ensure compliance when reporting the 99211.
As a bonus, Terry discusses the use of an insurance waiver when needed.
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The post Appropriately Reporting 99211 Services appeared first on Terry Fletcher Consulting, Inc..
On this edition of the CodeCast Podcast, Terry gives you the top ten Telehealth changes to implement or get ready for now.
Now that the PHE is over, there’s no time to wait to make sure you are compliant with your Telehealth delivery of care.
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The post Top 10 Telehealth Changes NOW! appeared first on Terry Fletcher Consulting, Inc..
There is an ongoing debate about ICD-10-CM and diagnosis coding: should we code the patient complaints, the signs and symptoms, or go straight to the definitive diagnosis?
When is it appropriate to code both? Do the payers really look at diagnoses? And how does this affect MA and value-based care and HCC capture?
Tune in this week as Terry answers these questions and sets the record straight.
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The post Should you code the definitive condition or signs/symptoms? [Fixed Audio] appeared first on Terry Fletcher Consulting, Inc..
It’s important to take stock of what could be lost in a technological transition from physician charting to “Dr. Echo” charting as it is referred to.
AI (Artificial Intelligence) chatbots (such as ChatGPT) are known to have what the coders call “hallucinations” or making up words that might follow another word. Do we want the patient record to reflect what an AI physician thinks should be documented?
Terry talks about this topic in the latest CodeCast with a warning about what needs to be tackled before a national or worldwide rollout of this latest technology.
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The post A Warning About AI Charting appeared first on Terry Fletcher Consulting, Inc..
With the current climate of audits, medical practices must have knowledgeable healthcare professionals who are up-to-date with regulatory guidance, CPT rules, ICD-10-CM rules, and all things related to pre-PHE and post-PHE regulations.
On this episode of the CodeCast Podcast, Terry Fletcher addresses concerns over what practices can and cannot bill for.
“Can I code for that?” Tune in to find out!
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The post Can I Really Bill For That? appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast Podcast, Terry talks about denial management codes, finding the patient’s MBI number, and understanding the realities of some Digital EM visits and ChatGBT responses to patients.
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The post Denials Management and EM Realities appeared first on Terry Fletcher Consulting, Inc..
There is so much published guidance out there for medical practices and professionals to use when setting policies in their offices. Every practice should have a compliance program, but most do not.
What happens when there is an infraction of regulatory rules? Do you have a plan, policy, or legal team in place to help? Or an external consultant like Terry Fletcher to turn to for help?
Tune in to this edition of the CodeCast podcast to determine if you are compliant – or if you are letting your providers push back on mandates.
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The post Top 10 Tuesday Q&A – Are You Compliant With Regulatory Guidance? appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast, Terry discusses the challenges of reporting an add-on service when no base code was performed.
Terry also covered urgent care versus retail care rules, and if it is appropriate to follow incident-to for these entities.
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The post Reporting add-on codes with no base code appeared first on Terry Fletcher Consulting, Inc..
For physician practices that use injectable drugs for stress tests, paid injections, or therapeutic services, some modifiers can assist in reporting to Medicare if there were discarded vials or if the drug was used in its entirety.
CMS originally had one modifier – the JW – to represent single-dose containers or single-use packages. Because of some misuses or misunderstandings on how to apply the modifier, a new modifier was created for 2023.
Terry discusses this update along with some possible physician query scenarios in this week’s CodeCast Podcast.
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The post Modifiers JZ and JW Discarded Drugs appeared first on Terry Fletcher Consulting, Inc..
A variety of channels have produced education on the 2021 and 2021 AMA E/M changes. Those channels include articles in CPT Assistant, AMA’s live and on-demand webinars, NAMAS, and even our own Terry Fletcher Consulting.
If that’s not enough, the AMA webinar on technical corrections added more clarification in key areas!
In this episode, Terry provides FAQs – Frequently Asked Questions – that were generated during these educational sessions, to level your E/M services with the new rules.
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The post 2023 E/M Frequently Asked Questions (And Answers!) appeared first on Terry Fletcher Consulting, Inc..
It’s time for another Top 10 Tuesday Q&A podcast, featuring our coding questions of the month.
Terry Fletcher will discuss a variety of topics including timely documentation rules for screening tests, what codes can be used for shared or split visits, and different rules for similar services.
Don’t miss this episode packed full of information for the coder, biller, administrator, and provider.
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The post Top 10 Tuesday Q&A – Coding Questions of the Month appeared first on Terry Fletcher Consulting, Inc..
The CPT Errata came out this week to clear up some confusion on coding for prolonged services. Time can be an audit trap for E/M services Are you supporting your prolonged-services when adding on CPT or HCPCS codes to E/M office and/or hospital services?
You don’t want this to be your audit trap: listen to this episode to make sure you stay compliant.
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The post Prolonged Services: An Audit Trap? appeared first on Terry Fletcher Consulting, Inc..
Advance care planning (ACP) is a voluntary, face-to-face service between a physician or other Qualified Healthcare Professional (QHP) and a patient, family member, caregiver, or surrogate to discuss the patient’s healthcare wishes if they become unable to make their own medical decisions.
In this week’s CodeCast Podcast, Terry discusses why the OIG has been getting involved in pointing out the non-compliant reporting and what Medicare’s newest directive includes on the service to be able to bill.
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The post Advance Care Planning OIG Watch List appeared first on Terry Fletcher Consulting, Inc..
Can “under-coding” fall under the FWA (Fraud Waste and Abuse) regulations for CMS? If you are falsely submitting a claim, yes!
Terry discusses the dangers of under-coding, how that could misrepresent your claim and also cause future payer audits.
We also talk about shoulder surgery coding and audio-only services that are changing once the PHE ends.
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The post Is “Under-Coding” Considered FWA? appeared first on Terry Fletcher Consulting, Inc..
Time has become a factor in almost every Healthcare patient encounter, It makes you wonder if physicians and providers are being baited into a false sense of security. When E/M only allowed time to document the visit if 50% or more was spent counseling, it was easier to quantify the time thresholds.
However, with “non-face-to-face” time also part of the total encounter, and a focus on new prolonged service codes, it begs the question: are we spending too much time with our patients?
Terry discusses this and more in this week’s Top Ten Tuesday episode of the CodeCast Podcast.
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The post Top 10 Tuesday Q&A – Spending too much time with patients appeared first on Terry Fletcher Consulting, Inc..
This edition of the CodeCast Podcast dives into denial management and appeals assistance for EKGs, and how to handle medical necessity denials.
Your host, Terry Fletcher, will also discuss some other topics, such as being accurate on UTIs (Urinary Tract Infections) ICD-10-CM codes. The split/shared visits continue to confuse coders and providers on how to document and report: Terry answers these questions and clears up the confusion.
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The post Claims Appeals Advice and More (Fixed Audio) appeared first on Terry Fletcher Consulting, Inc..
This editions of the CodeCast Podcast dives into denial management and appeals assistance for EKGs, and how to handle medical necessity denials.
Your host, Terry Fletcher, will also discuss some other topics, such as being accurate on UTIs (Urinary Tract Infections) ICD-10-CM codes. The split/shared visits continue to confuse coders and providers on how to document and report: Terry answers these questions and clears up the confusion.
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The post Claims Appeals Advice and More appeared first on Terry Fletcher Consulting, Inc..
On this edition of the CodeCast Podcast, Terry Fletcher shares insights into the new SDoH ICD-10-CM coding when reporting a level 4 or moderate E/M service.
Terry also talks about finding joy in your job. What makes you happy when you are doing certain tasks in your healthcare career?
Let’s focus on finding that happiness to stay motivated.
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The post SDoH for Moderate Risk EM (Fixed Audio) appeared first on Terry Fletcher Consulting, Inc..
It seems like the Telehealth ERA exploded not only virtual healthcare but also “digital healthcare” platforms.
In this episode of the CodeCast Podcast, Terry discusses when virtual and digital should intersect in in-person and the impact of the now, scheduled end of the PHE this spring.
Also, discussions of CCM activities that can be counted towards time thresholds, and how to use better language when emailing and communicating with your colleagues.
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The post Should All Healthcare Be Digital? appeared first on Terry Fletcher Consulting, Inc..
With new legislation in the 2023 Omnibus Bill (signed into law 12/29/22), extending many 1135 PHE waivers through 2024, there are also some scaled-back rules that healthcare professionals will need to know, and not assume are still in effect, as you report 2023 services.
Remember to always read the fine print before moving forward.
Too many coders, billers, and providers rely only on TV for their news. We have a clear update for you today on the CodeCast podcast.
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The post Top 10 Tuesday Q&A – Fine Print of the Omnibus Bill appeared first on Terry Fletcher Consulting, Inc..
Many Coders tend to read a physician’s note and make assumptions without first reading the coding guidelines. One particular entry, which is found in many admission notes is “elevated troponin”. An elevated troponin does not always mean that a heart attack has occurred, many many coders will leap to that conclusion before reviewing the documentation.
In this week’s CodeCast Podcast, Terry will clarify when this clinical symptom is a potential AMI and what to look for to confirm correct ICD-10-CM coding. Also on the podcast is the POS war between inpatient and hospital observation coding for 2023.
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The post Elevated troponin levels: may not be what you think! appeared first on Terry Fletcher Consulting, Inc..
Instructional notes in ICD-10-CM are there for a reason. “Code First” denials are happening more often, when these directions are not followed.
In this jam-packed episode, Terry discusses when certain conditions have instructional notes that mandate sequencing, the rules for them, and how this impacts your reimbursement.
Also, Terry shares some recent changes to the NSA rules for arbitration.
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The post ICD-10-CM “Code First” Clarifications appeared first on Terry Fletcher Consulting, Inc..
In this episode, Terry discusses late entries, addendums, or corrections to a medical record that are legitimate occurrences in the documentation of clinical services.
Compliance is always an issue in this act and Terry clears up the confusion. A late entry, an addendum or a correction to the medical record, must bear the current date of that entry – and is signed by the person making the addition or change.
Also, some discussion of coding NSTEMI myocardial infractions.
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The post Addendums, corrections and late entries to the medical record appeared first on Terry Fletcher Consulting, Inc..
As 2023 arrives, many coding professionals might be thinking about their career goals, maybe a career change, or just enhancing their current position in coding.
In today’s work environment, it is important to be flexible. How does that relate to the coding professional?
Flexibility ultimately leads to stability, as it provides coding departments with employees who can cross aisles to help out amidst staffing shortages. It also enables them to learn new skills to grow in their position.
Terry discusses how coders and healthcare professionals alike can use the concepts of flexibility plus creative thinking to expand their skill sets.
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The post Life as a Coder Equals Flexibility appeared first on Terry Fletcher Consulting, Inc..
For the last CodeCast podcast of 2022, Terry gives quick fire details on the new 2023 EM Rules for Data Points, plus reminders on what to make sure you are documenting to support medical necessity in the history and physical as well.
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The post 2023 EM Data Points Reminders appeared first on Terry Fletcher Consulting, Inc..
When using time to level your E/M visit in 2023, you need to focus on the individual patient.
In this week’s CodeCast, Terry talks “time” when giving auditing tips to consider when your providers use it to level their E/M encounters.
This is low hanging fruit for payers to find an issue. You want to be sure you are doing things right heading into the New Year.
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The post Time-Based EM for 2023 appeared first on Terry Fletcher Consulting, Inc..
On this edition of the CodeCast, Terry Fletcher defines the laymen’s terms for definitions of all fractures,
She also has an update on the 2023 rules for prolonged services.
And don’t miss her personal tidbit as it may help those of you having trouble with the hard-to-buy for person this holiday season!
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The post Fractures Defined appeared first on Terry Fletcher Consulting, Inc..
Terry tackles a challenging topic in the appropriate documentation of prescription drug management when reporting moderate level E/M codes.
Doctors need to know that adding the current medication list to the progress note is not adequate to support this level of risk. Prescription drug management is based on documented evidence that the physician has evaluated medications as part of a service that is provided.
In this edition of the CodeCast, Terry breaks down the definition of PDM and how to support this part of an encounter to receive credit for it.
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The post E/M: Prescription Drug Management Defined appeared first on Terry Fletcher Consulting, Inc..
In this Top Ten Tuesday edition of the CodeCast, Terry answers frequently asked questions about ACP and PHE extensions, Orthopedic procedures, and Gastro endoscopy. Tune in to to hear her insight on these topics and more.
The post Top 10 Tuesday Q&A – Multi-Specialty Questions appeared first on Terry Fletcher Consulting, Inc..
There has been a lot of confusion, on when it is appropriate to bill for e-Visits, using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. The patient must verbally consent to receive these services, and the patient must be informed that Medicare coinsurance and deductible would apply to these services. Terry discusses the rules […]
The post eVisits the Portal Connection appeared first on Terry Fletcher Consulting, Inc..
The U.S. will extend the COVID-19 public health emergency through at least April 11, 2023, Biden administration officials confirmed to CNBC on November 11th. But why? Does this make sense with the COVID pandemic virtually over? HHS last renewed the PHE on October 13th for an additional 90 days to January 11th, 2023 — it […]
The post Are they really extending the PHE again? appeared first on Terry Fletcher Consulting, Inc..
The Medicare 2023 PFS and the CMS Final Rule were published on November 1st. In this episode of the CodeCast podcast, Terry does a deep dive into the specifics so that you have an idea of what your reimbursement cuts will be, where Telehealth stands in 2023, and any new regulatory guidance for procedures that […]
The post The Medicare Final Rule and 2023 PFS Summary appeared first on Terry Fletcher Consulting, Inc..
This episode of the CodeCast Podcast discusses Preventative Medicine confusion and how to explain to your patients the difference between IPPE, AWV, and Routine Annual PEs. Terry Fletcher will explain what is and isn’t covered. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX […]
The post Understanding Preventative Medicine Codes appeared first on Terry Fletcher Consulting, Inc..
This episode of the CodeCast Podcast discusses Preventative Medicine confusion and how to explain to your patients the difference between IPPE, AWV, and Routine Annual PEs. Terry Fletcher will explain what is and isn’t covered. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX […]
The post Understanding Preventative Medicine Codes appeared first on Terry Fletcher Consulting, Inc..
HHS recently published a data brief on Telehealth Compliance Risks during the first year of the pandemic. It outlines what they are investigating, what you should be aware of, and how to take proactive steps to correct any errors. In this week’s CodeCast Podcast, Terry discusses this brief along with her own commentary on corrective […]
The post Top 10 Tuesday Q&A – Telehealth Compliance Risks appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast podcast, Terry Fletcher discusses the front desk staff and how they are key to a practice’s success. Tune in to find out how you can capture success with your front office team as Terry shares insights on how to make that position your own: and how the front desk […]
The post The front desk is your starting point for an efficient office appeared first on Terry Fletcher Consulting, Inc..
Making the Decision to use -25 can be a tough one because first, you need to know if the “significant separately identifiable” CPT definition was met. Second, the coding provider must be able to defend the history, examination, medical knowledge, professional skill, and work time that was above and beyond what is usually required solely […]
The post Using The 25 Modifier Correctly appeared first on Terry Fletcher Consulting, Inc..
When a provider uses time as the factor to determine the level of care, how do they document what elements were done regarding that time? A statement that says “greater than 30 minutes was spent…” is not acceptable. Terry gives her insights into “time-based” coding for E/M services in 2022 and into 2023. Listen to […]
The post Time-Based EM Coding appeared first on Terry Fletcher Consulting, Inc..
The No Surprises Act took effect on January 1, 2022, and has had dramatic effects on how U.S. healthcare providers are required to conduct their business operations. The NSA seeks to protect patients from surprise medical bills and prohibits balance billing of patients for certain out-of-network care. However, there is still confusion in medical practices […]
The post Top 10 Tuesday Q&A – No Surprises Act Top appeared first on Terry Fletcher Consulting, Inc..
October 1st is the effective date for the biggest change in diagnosis coding in a few years. There will be almost five times as many new codes in 2023 than there were in 2022. On this edition of the CodeCast podcast, Terry breaks down the most impactful changes. With 1,179 new codes (153 in 2022), […]
The post ICD-10-CM 2023 Update appeared first on Terry Fletcher Consulting, Inc..
In this day and age of texting, shortcuts, and acronyms, Terry takes a look at the Business of Medicine Acronyms you can use every day. Terry also talks about the appropriate level of exam needed for E/M that may not be clear in CPT. Note: You may find a full list of these acronyms referenced […]
The post Business of Medicine Acronyms appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast Podcast, Terry gets into specialty coding ICD10-CM for gastro and colon polyp coding. Terry also discusses ICD10-CM codes for bullying and the AHA definitions that will help you decide if this is a clinical option. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 […]
The post ICD10-CM Colon Polyps Coding appeared first on Terry Fletcher Consulting, Inc..
New 2023 E/M Guidelines were recently proposed, each with its own interpretation. Join Terry for a quick look at expectations for 2023 for Evaluation and Management Services, which will hopefully lead you to her webinar training schedule this fall. (Because nothing replaces actual education and materials!) Subscribe and Listen You can subscribe to our podcasts […]
The post Top 10 Tuesday Q&A – E/M 2023 Update Quick Look appeared first on Terry Fletcher Consulting, Inc..
Terry Fletcher returns with another episode of the CodeCast Podcast to discuss hospice modifiers when Part B services are performed during a Part A hospice stay. Remote or work-from-home employee compliance is necessary to avoid penalties if HIPAA or OSHA comes knocking. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – […]
The post Hospice Modifiers and Remote Workspace appeared first on Terry Fletcher Consulting, Inc..
The HIPAA Right of Access gives people the right to inspect their protected health information that is held by a HIPAA-covered entity, check the information for errors, and request that any errors are corrected. In this episode of the CodeCast podcast, Terry discusses what patient’s rights are but also what the healthcare provider’s responsibility is […]
The post Information Blocking Realities appeared first on Terry Fletcher Consulting, Inc..
This edition of the CodeCast podcast defines migraine, arrhythmia, and signs or symptoms language with ICD-10-CM rules, so that diagnosis coding can be easier to capture. It’s all a puzzle and Terry Fletcher helps you find the missing pieces! Terry also offers some PSA tips that you don’t want to miss: but be warned, she’s […]
The post ICD-10-CM coding for migraines, arrhythmias, and more appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast Podcast Terry Fletcher goes over the published CMS Strategic Plan. This plan will affect provider practice workflows, along with clarifications on EM Data Points, and updates for the Prolonged Service add-on code. Make sure you check out this information-packed program! Subscribe and Listen You can subscribe to our podcasts […]
The post CMS Strategic Plan for 2022 appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast, Terry continues her Top 10 Tuesday series with allergy, orthopedic, 25 modifier, and cardiology questions, plus more. These responses can impact your workflows along with your understanding of coding concepts. Tune in for a mixed bag of coding questions that have reimbursement complications you don’t want to miss! Subscribe […]
The post Top 10 Tuesday Q&A – Mixed Bag of Coding Questions appeared first on Terry Fletcher Consulting, Inc..
There have been a lot of discussions lately on whether or not Coders are Billers and vice versa. In the grand scheme of things, what do you want your employer (or potential employer) to consider your role as? On this episode, Terry discusses the differences and also touches on the current status of the PHE. […]
The post Are you a Coder or a Biller? Let’s find out! appeared first on Terry Fletcher Consulting, Inc..
On July 7, 2022, CMS issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues. Those changes are effective on or after January 1, 2023. On this episode of the CodeCast podcast, Terry gives us the […]
The post Medicare PFS Announcements appeared first on Terry Fletcher Consulting, Inc..
This week’s CodeCast podcast revisits the topic of “Incident to.” The last time this was covered on the show was back in February 2021. That is well over a year ago! Now with more and more practices hiring NPs and PAs, we need to make sure we know and follow, the rules. A recent report […]
The post Revisiting NPP Incident to Coding Rules appeared first on Terry Fletcher Consulting, Inc..
A healthcare practice must verify the patient’s coverage and eligibility for medical services being sought and determine their responsibility for payment. Through the patient eligibility and benefits verification process, physician practices can confirm the coverage offered by the health plan and share of cost by the patient in the form of co-payments, deductibles, and coinsurance. […]
The post Top 10 Insurance Verification Tips appeared first on Terry Fletcher Consulting, Inc..
Many payers are starting to put restrictions on payment and submission requirements when billing the 25 modifier on E/M services with minor procedures on the same date. You will see reductions in payments and new paperwork requirements for submission. Terry tears into the update in this show, plus bonus information on the CPT Errata June […]
The post Breaking News: 25 Modifier Chaos Coming appeared first on Terry Fletcher Consulting, Inc..
This week, Terry introduces a new ICD-10-CM topic of HCC (Hierarchical Condition Category) coding relies on ICD-10-CM coding to assign risk scores to patients. Each HCC is mapped to an ICD-10-CM code. Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. […]
The post HCC Coding Compliance appeared first on Terry Fletcher Consulting, Inc..
This week on the CodeCast Podcast, Terry Fletcher discusses the differences between the IPPE, AWV and a routine physical exam. Many providers are billing E/M services to “establish care” and this may not be accurate. Listen to find out why and how to avoid this common problem. Subscribe and Listen You can subscribe to our […]
The post IPPE, AWV and other Preventative Payable Visits appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast, Terry continues her Top 10 Tuesday advice on clarifications to the 2021 EM Guidelines for Office and Other Outpatient visits. There is still a lot of confusion: and with the 2023 rules only months away, we need to figure out how to navigate the newest rules. Subscribe and Listen […]
The post Top 10 Tuesday Q&A – E/M 2022 Q&A Continued appeared first on Terry Fletcher Consulting, Inc..
This week Terry’s focus on “coding” looks into add on codes and their descriptors: mainly the three types of add-on codes as described by CMS. Is there ever a time that an add-on code can stand alone? Maybe! Tune in this week for this new topic on medical billing coding. Subscribe and Listen You can […]
The post Coding for Add-on Codes appeared first on Terry Fletcher Consulting, Inc..
This week on the CodeCast Podcast, Terry discusses some important tips to successfully negotiate your payer contracts. By the way: this should include your coders as part of the negotiating process! Terry also covers other topics such as focusing on payers that are below the Medicare fee schedule, ancillary services coverage, and incorporating coverage policies […]
The post Tips for Negotiating Payer Contracts appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast Podcast, Terry gives regulatory guidance for Fee-For-Service Time Compensation (previously known as Locum Tenens) billing and coding. She also covers the rules surrounding how to document these services. Plus, CMS updated their COVID-19 FAQ sheet again, and this time it includes HCC’s and Telehealth inclusion for Risk Adjustment. You […]
The post Locums Tenens Physicians appeared first on Terry Fletcher Consulting, Inc..
There should be several goals to meet during a Telehealth patient encounter, such as replicating an in-person clinical encounter as closely as possible. The strategies for incorporating learners into the visit should be the same as for in-person encounters. Proponents of Telehealth have not addressed this issue, however, Telehealth should be expanded. Terry discusses the […]
The post Telehealth Webside Manner appeared first on Terry Fletcher Consulting, Inc..
The PHE was extended for another 90-days, but not all waivers made the cut. Tune in to find out what waivers will expire, what is still in play, and how state rules versus federal rules play out when physicians cross state lines via Telehealth. Subscribe and Listen You can subscribe to our podcasts via: Apple […]
The post PHE Extended But Some Waivers Expired appeared first on Terry Fletcher Consulting, Inc..
Medical Acronyms like LVEDP or HIPAA or PHE are now an everyday part of a medical coder’s and biller’s life. Do you know what they mean and do you have a reference guide for your desk? Listen this week as Terry does a run-through of what you need to do your job and also answers […]
The post Medical Acronyms Defined appeared first on Terry Fletcher Consulting, Inc..
Remote working is here to stay, so today’s episode of the CodeCast podcast is about how to not only manage your remote workforce but how to be successful as a remote healthcare worker. This episode also includes coding questions regarding MUEs and Carotid Stenting. Subscribe and Listen You can subscribe to our podcasts via: Apple […]
The post How To Manage Remote Workers appeared first on Terry Fletcher Consulting, Inc..
For healthcare professionals that appeal claims as their job, it can feel like a futile and unrewarding act. In this episode of the CodeCast, Terry Fletcher discusses the five facts of successful claims appeals and collections, and how to focus on what is important in the process. Also, Terry talks about the latest updates for […]
The post 5 Facts for Successful Claims Appeals appeared first on Terry Fletcher Consulting, Inc..
Terry Fletcher continues the coding tips and answers from CMS series in the latest episode of the CodeCast. This show focuses on how to interpret the rules for the 2021 E/M Guidelines, as well as Prolonged Services, Time vs MDM, and clarifying the carve-outs for time. Subscribe and Listen You can subscribe to our podcasts […]
The post Top 10 Tuesday Q&A – 2021 E/M Documentation Tips Continued appeared first on Terry Fletcher Consulting, Inc..
Administrators, coders, and physicians should periodically conduct a patient chart audit to assess whether your doctors code accurately and to make sure all services are being captured. But how do you know, that they know, what they’re doing? Terry discusses her methods when beginning and engaging in an audit. She’ll talk about what she has […]
The post Has your practice ever had a patient MR audit? appeared first on Terry Fletcher Consulting, Inc..
This week’s CodeCast podcast spotlights the Gastroenterology Specialty. Terry discusses colonoscopies, screenings, diagnostics, therapeutics, and surveillance. She also gives definitions, coding guidance (for both Medicare and Commercial plans), and what to look for when adding modifiers for maximized reimbursement. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Google Podcasts […]
The post Specialty Spotlight: Gastro Screening and Endo Coding appeared first on Terry Fletcher Consulting, Inc..
Terry Fletcher focuses on billing an E/M service on the same date as a minor procedure in this packed episode of the CodeCast Podcast. There are Medicare rules about this, and we receive denials when this is incorrectly billed. That’s why it’s important to take a look at when it is appropriate for different specialties. […]
The post Billing an E/M service on the same date as a minor procedure appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast podcast, Terry is responding to many listeners’ requests for auditing tips when auditing E/M services. She focuses on what to look for when moderate visits are being coded under “Prescription Drug Management” and also clarification on how to report Critical Care time. Subscribe and Listen You can subscribe to […]
The post Auditing Tips for Auditors appeared first on Terry Fletcher Consulting, Inc..
Due to the continued confusion on how to document office visit codes 99202-99215 from the 2021 rules, Terry’s Top Ten Tuesday segments over the next few months will be dedicated to these services. Questions and answers will be from CMS sites and best practices, however, these do not apply to other categories or procedure codes. […]
The post Top 10 Tuesday Q&A – E/M 2022 Office Visit Documentation Tips appeared first on Terry Fletcher Consulting, Inc..
In this episode of the CodeCast podcast, Terry gives a rundown of the 2022 updates for POS (Place of Service) codes and modifiers, plus when they should be implemented for Medicare and commercial plans. Terry also clears up any confusion on the start dates with the PHE still continuing until April. Subscribe and Listen You […]
The post Modifier and POS Update for 2022 appeared first on Terry Fletcher Consulting, Inc..
The No Surprise Billing Act may be the most poorly written, difficult to understand set of regulations that have ever been rushed to publications. This is why, much of the guidance out there is misleading, if not entirely wrong. This week’s CodeCast features Terry discussing the true definition of “balance billing” and what four things […]
The post No Surprise Act: What you need to know now appeared first on Terry Fletcher Consulting, Inc..
Medicare has clearly lost their minds, allowing split/shared visits in a hospital setting where it is “optional” to have a physician provide a face-to-face. As if that isn’t going to cause bad actors to come out! Yes, a face-to-face is still needed, but according to the new 2022 rules: “…the FTF doesn’t necessarily have to […]
The post What was Medicare thinking? Split/shared visits revisited appeared first on Terry Fletcher Consulting, Inc..
With the PHE extended for the eighth time during the pandemic, now through April 18th, 2022, it is more important than ever to do a coding and compliance fact check to avoid scrutiny during an OIG Audit. Terry Fletcher shares her top ten coding, billing, and compliance questions of the month, focusing directly on Telehealth. […]
The post Top 10 Tuesday Q&A – Telehealth Coding Questions appeared first on Terry Fletcher Consulting, Inc..
In 2022, CMS is no longer allowing shared services to be billed in an office setting and updated their 2022 definition of Split and/or Shared visits to be primarily in a facility setting. In this week’s podcast, Terry dives into this topic, pulling from not only her rules interpretations but also industry-trusted sources. This important […]
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CMS is ramping up their audit focus with new funding and personnel to handle the work. Incorrect coding and overpayments, or CERT Audits, becomes the CodeCast topic of the day as Terry Fletcher dives into each aspect so you’re best prepared to handle what’s coming. Cardiology had a 5.2% error rate for the 2018-2019 year […]
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What breaking news for CMS and other payers do we need to be aware of as 2022 begins? Terry discusses the new PFS, the AUC implementation, and the COVID mandates under the Omnibus rules. As healthcare professionals, we have to be on top of the flow of information and ready for it to be implemented. […]
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Errors in physician billing are common. One of the most common errors is the failure to electronically file a clean claim. This week, as we end out the 2021 year, Terry gets back to basics with coders and billers in her Top 10 Tips for Clean Claims and how to make sure you have a […]
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The PHE will eventually expire and with it the many waivers and exceptions to Telemedicine rules. A few efforts taken now can help reduce the risk a company will find itself on the receiving end of an overpayment demand or a False Claims Act investigation. Terry discusses the OIG 7 audits for Telehealth and what […]
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Medicare physicians can rest a little easier in 2022. The House and Senate came to a bipartisan agreement to put a band-aid on the severe cuts that were set to take effect on January 1st, 2022. The passing of the Bill comes as a major sigh of relief for physicians and providers that were looking […]
The post Medicare Fee Schedule 2022: Last Minute Relief appeared first on Terry Fletcher Consulting, Inc..
The headlines have been dominated by vaccine mandates in recent weeks. Terry Fletcher is here to break down the reality between the OHSA and CMS/Omnibus mandates on the latest CodeCast, and where the country stands on this polarizing topic. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Google Podcasts […]
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It’s once again Top Ten Tuesday time, as Terry has a mixed bag of coding, billing and compliance Q&A’s to review. From TAVR Coding, Telehealth, Mastectomy Coding, and the 2022 Medicare Fee Schedule, she leaves no stone unturned. Listen to this episode for all of the latest updates. Subscribe and Listen You can subscribe to […]
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This week on the CodeCast podcast, Terry gets back to specialty coding with her cardiology coding tips for the Cath Lab and discusses what Medicare means by MUE’s. Listen in to this week’s episode. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX Stitcher […]
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Medical assistants have a narrow list of things they can and cannot do for patients or a physician in a doctor’s office. It’s often difficult to know what’s allowed because there are no strong laws regarding medical assistants in place. Most MAs learn their skills on the job. In this week’s CodeCast podcast, Terry talks […]
The post What is a Medical Assistant? And what can they do? appeared first on Terry Fletcher Consulting, Inc..
The Medicare Physician Fee Schedule and Final Rule was posted on November 2nd. In this week’s episode, Terry goes over the highlights of the new rules, the new conversion factor for 2022, and the status of expanding Telehealth in 2022. Join us for this update. Subscribe and Listen You can subscribe to our podcasts via: […]
The post The MPFS and Final Rule is out for 2022 appeared first on Terry Fletcher Consulting, Inc..
Trick or treat! In this episode of the CodeCast Podcast, Terry gets spooky with her top ICD-10-CM Halloween coding options for diagnoses. Also, Terry talks about coding a knee synovectomy and what the coder is looking for in the report to capture the CPT’s correctly. Subscribe and Listen You can subscribe to our podcasts via: […]
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(CMS) announced that Targeted Probe and Educate (TPE) audits would resume on September 1, 2021. Terry discusses what to look for, what to be ready for, and how to prepare for these very specific and as they say targeted audits for physicians, NPPs, and hospitals. Subscribe and Listen You can subscribe to our podcasts via: […]
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With state-to-state PHE mandates expiring, extending, or not renewed, Terry takes a look at where half of the country, and the government, is on the PHE, as we look to Telehealth compliance and continuing to make sure we are following the rules of reporting. Subscribe and Listen You can subscribe to our podcasts via: Apple […]
The post Where we are now with Telehealth and PHE? appeared first on Terry Fletcher Consulting, Inc..
Terry’s passion shines in this episode, as she discusses government-ordered vaccine mandates. Staff shortages in ASC’s are prompting them to suspend services. This begs the question: are these mandates helping or hurting our communities? Giving employees a choice of getting a vaccine, versus weekly testing and PPE for safety, should be considered. Our patients need […]
The post Are ASC and hospital vaccine mandates helping or hurting our communities? appeared first on Terry Fletcher Consulting, Inc..
The fiscal year 2022 ICD-10-CM diagnosis code updates will become effective on October 1. There are eight key things to know: and Terry is on top of it in this episode of the CodeCast Podcast. Some of the new rules include coders and physicians on the same page, laterality capture by “other clinicians” and SDoH […]
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Terry discusses best practices for coders when questioned and their ability to communicate logical answers to back up their assessments. Many coders may struggle with this newfound communication concerning the daily challenges of maintaining productivity. Coders are relearning time management and organizational skills to better manage productivity, including email communication in their workday. Especially with […]
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Terry discusses, the importance of Coding With Authority and accuracy when coding and reporting services. She emphasizes making sure you read your code descriptor and also try to not get your terms mixed up. (Such as supervision vs. scope of practice.) Also discusses are the importance of authoritative references, and a bonus discussion on the […]
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This week on the CodeCast podcast Terry discusses a variety of healthcare industry headlines, including new ABN instructions, a delay in certain NSA regulations, and EM 2021 Coding questions (to clarify Data Point counts). It’s a packed episode this week, you won’t want to miss it. Subscribe and Listen You can subscribe to our podcasts […]
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Kicking off the CodeCast in September, Terry discusses auditing and the objectives of looking for documentation support of the E/M record. Terry focuses on not losing sight of “medical necessity” within the record and making sure the physician (or provider) can justify not only the level of E/M service but also the ordering of tests […]
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In this month’s Top Ten Tuesday CodeCast, Terry discusses what a chronic condition is versus a symptom, EEG coding, and shared visit compliance. We have a mixed bag of coding and compliance questions that will shed some light on multiple specialty issues that are making headlines this month. Subscribe and Listen You can subscribe to […]
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Terry fractured her thumb this week… so in the spirit of personal knowledge, she discusses five frequently asked questions on pathological fracture coding for ICD-10-CM! Also, Terry revisits improving medical practice receivables and collection practices: while providers are on vacation and we are focused on working our A/R’s. Subscribe and Listen You can subscribe to […]
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This episode of the CodeCast Podcast focuses on physician documentation as it relates to coding. There is a saying, “There is no coding without documentation, doctors are required to use words.” AHIMA and AHA stand behind this statement. More and more I am seeing coders making leaps to moderate and even high risk for patient […]
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The widespread belief that HIPAA confers a strict set of privacy protections to all health data — and that everyone is subject to those laws — are common mistakes. More often than not, it’s believed to be “HIPPA”, the Health Information Privacy Protection Act… but that law doesn’t exist! The proper acronym, HIPAA, doesn’t have […]
The post Do you really know what HIPAA means? appeared first on Terry Fletcher Consulting, Inc..
In the latest episode of the CodeCast, Terry compiles all of the breaking news in healthcare to update you on what the heck is going on! Topics include: – NSA – No Surprises Act – Medical Billing – In-Patient-only list adjustment midyear – Uber in healthcare – And some Medicare coding updates for G-codes Subscribe […]
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Government and private insurers’ audits have revealed too many cases of fraud and/or abuse in medical billing and reporting. You must avoid improper billing practices, and coding mistakes to steer clear of trouble and maintain a flourishing practice. Terry discusses the top ten medical coding and billing mistakes and how to avoid them. Subscribe and […]
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The 2022 Official Coding and Reporting Guidelines, including the fiscal year 2022 ICD-10-CM codes, were released last week by the Centers for Disease Control and Prevention (CDC). Terry gives you a look into these new, highly anticipated rules which are effective October 1st – which also include post-COVID-19 condition directions. Subscribe and Listen You can […]
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Since most people initially dial in to make an appointment, the first impression of your medical practice isn’t through the front door: it’s your voice on the phone. If you come across on the phone as hurried or annoyed, that’s how people might think the practice is. In this episode, Terry discusses phone etiquette tactics […]
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As physicians are taking summer vacations and time is freeing up for billing departments, it’s as important as ever to remain sharp. For example, do you know how much outstanding accounts receivable you have in your 0-30 day, 30-60 day, 60-90 day, 90-120 day and 120-plus day categories? Knowing the answer to this question will […]
The post Accounts Receivable: Where is your A/R? appeared first on Terry Fletcher Consulting, Inc..
On the latest episode of the CodeCast podcast, Terry Fletcher goes over the top ten ICD-10-CM errors and how to make sure you are careful not to make them. Terry also looks past code book guidelines to focus on updates – to realize that ICD-10-CM codes are “money codes”. You cannot get paid without accurate […]
The post Top 10 Tuesday Q&A – ICD-10-CM Coding Mistakes appeared first on Terry Fletcher Consulting, Inc..
Telehealth has served as a lifeline for many during the pandemic, ramping up from a minority share of office visits to a majority, at least for a while. Still, Telehealth cannot replace hands-on care for some conditions. For those not equipped with speedy broadband internet service or smart devices, it can be difficult or impossible […]
The post Telehealth Patient Queries appeared first on Terry Fletcher Consulting, Inc..
On the latest CodeCast, Terry Fletcher references some trusted legal blogs and resources for SMRC Audits and the PHE State level June expirations. if you are not on top of these topics, each could affect your practice and provider liability. Also, some coding questions and answers pertain to the cardiology interventional specialty, and making sure […]
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Terry Fletcher returns with reasons to implement and update your IT to have true Interoperability for patient-centric care: Cloud access, IT upgrades, ease of Prior Authorizations, and new CURES Act patient access will all be part of being prepared. Terry also discusses the COVID pandemic and the homeless population. Where is the data? SDoH must […]
The post 5 Tips to True Interoperability and SDoH links to COVID appeared first on Terry Fletcher Consulting, Inc..
Are you ready to continue offering Telehealth once the PHE ends? Have you assessed your policies and procedures to make sure you are using “Best Practices” standards?
The PHE will end and telehealth will be expanded: that is not a question.
What is your office prepared to offer once some of the regulations roll back and some are allowed to be permanent? Do you have a HIPAA-protected platform once smartphone devices are no longer allowed?
These questions and more are answered in this episode of the CodeCast podcast. Tune in for your road to Telehealth Best Practices.
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Terry Fletcher returns with her Top 10 Tuesday coding, billing and reimbursement questions for the month.
There is a lot to cover from EM Errata clarifications, HIPAA violations on patient email, and orthopedic dislocation coding.
Tune in for a mixed bag of answers to the top coding questions for the month of May.
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States are reopening sooner than the federal PHE is ending. If your healthcare organization has taken advantage of Federal 1135 blanket waivers during the National Public Health Emergency (PHE), be sure to review those waivers as you prepare for a survey (accreditation) to check if any were inconsistent with requirements under your state emergency or pandemic plan.
The 1135 blanket waivers apply to requirements for Federal programs. However, some of the waivers could be superseded by requirements set by state or local authorities (having jurisdiction) – if that is stated in a particular waiver and is included in your state’s emergency or pandemic plan.
Terry discusses the above topics plus outsourcing of your RCM. Is it a good time to do it? And if so how?
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OIG is to Audit Medicare Payments for COVID-19 Discharges to determine, and investigate, whether hospitals billed for the 20% add-on Medicare payment for COVID-19 discharges correctly.
OIG’s work plan now states that a positive lab test has to be found within the documentation for all patients admitted and discharged after September 1st, 2020 to qualify for the 20% bump in payment.
Terry discusses the details of this audit, plus the specimen and handling code 99000: and is it billable?
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Many commercial payers voluntarily waived all deductibles, co-pays, and other costs for insured patients who fell sick with COVID-19. Many of these patients were hospitalized and needed intensive care, doctor visits, medications, or other treatments.
Setting aside those fees was a good move from a public relations standpoint. The industry got credit for helping customers during tough times. And it had political and financial benefits for insurers, too. But nothing lasts forever.
Starting at the end of last year, and continuing through the first quarter of 2021, many insurers are quietly ending those fee waivers for COVID treatment and patients are finding out after the fact. Terry discusses how to be proactive in making sure you and your patients are informed and why this will be the theme of 2021.
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The post Insurers have started rollbacks of patient share of cost appeared first on Terry Fletcher Consulting, Inc..
We all know that Medicare has their definition of “Medical Necessity” under Title 18 of the Social Security Act.
But did you know that the AMA, The American College of Medical Quality, AAFP, and many Payer Contracts have their own defined language of what “Medical Necessity” means?
This week Terry discusses all of them to make sure that you are clear, legal, and compliant when submitting claims for services for your patients. You want to be right the first time!
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Terry discusses the recent CMS alerts and new coding questions relating to the 2021 EM Rules.
Medical Decision Making has everyone confused.
Can vaccines and immunizations be considered in the management of a patient? Where does a pre-op visit for surgery fall in the presenting problems addressed?
Terry discusses these topics and more in this episode of the CodeCast podcast.
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The post PHE Extended and more EM2021 MDM Clarifications appeared first on Terry Fletcher Consulting, Inc..
This week’s CodeCast focuses on the 21st Century Cures Act or the “Information Blocking” regulations.
The regulation became effective last Monday, April 5th, so you must know what is necessary when a patient requests their records and how you could get into monetary trouble if not compliant with their request.
Also, when coding for Atherosclerotic Heart Disease, be alert to the details when you choose an ICD-10-CM code.
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March Madness wasn’t only about college basketball! Medicare made the first quarter of 2021 all about announcements.
Listen to this week’s episode as Terry runs down the new CMS/Medicare announcements, regulation effective dates, and the AAP repayment start.
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The post Medicare alerts: AAP, COVID vaccines, and more appeared first on Terry Fletcher Consulting, Inc..
We are working so many hours since the pandemic hit in January 2020.
Over a year into the COVID Public Health Emergency, healthcare professionals, like other employees, had to emergently pivot to working remotely. This has blurred the boundaries between work and home.
Let’s talk about how to “Zoom” out our Fridays with Terry this week as she talks about your mental weariness and how to refresh and refocus.
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Every year CMS releases an updated inpatient-only surgery list: and the surgeries on this list are not arbitrarily selected.
Due to the complexity of the procedure, the risk for complications, the need for post-operative monitoring, and an anticipated prolonged time for recovery, CMS understands that these surgeries require a high level of care.
Terry discusses some of these procedures in this episode of the CodeCast podcast and why it is important not only to your practice revenue but your patient’s financial choices.
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The post What is an “Inpatient-Only Surgery List”? appeared first on Terry Fletcher Consulting, Inc..
So many providers have been looking into setting up either an OBL (Office-Based Lab) or an ASC (Ambulatory Surgery Center) with their partners.
Terry discusses the topic in general terms before you dive in to determine if this could be a way for your providers to get back to a profitable practice. After the year we have had this could offer convenience to the patient to get those elective surgeries and procedures done now.
If you haven’t considered this before, listen to this podcast and the reimbursement impact and you may start considering the possibility now.
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Virtual Check-ins have been confusing: not only on when to use them, but CMS added more to the list in 2021!
The confusion continues for physicians, NPs, PAs and therapy ancillary staff on when to use these HCPCS G-codes, or what Terry refers to as, “G-we are watching you!”
The episode of the CodeCast should clear up any confusion on usage, and help to make sure you are capturing these services appropriately.
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This week Terry talks about 99211 compliance, and when it is appropriate to report the “nurse” code.
Also, Medicare as a Secondary Payer (MSP) can see many denials. CMS issued a new policy on the topic: we have the details.
CMS also added a new “virtual check in” G code for other ancillary staff. Find out if you can report it on this episode of the CodeCast Podcast.
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The post When should I report the 99211 Code? appeared first on Terry Fletcher Consulting, Inc..