PODCAST

CodeCast | Medical Billing and Coding Insights

Terry Fletcher

Taking the Business of Medicine to the next level

business

All Episodes

7:55

2024 Pelvic Exam Add-On Code

CodeCast | Medical Billing and Coding Insights ·

2023/12/26

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. Subscribe and Listen You can subscribe […] The post 2024 Pelvic Exam Add-On Code appeared first on Terry Fletcher Consulting, Inc..

en-US

12:05

When to use the new SDoH add-on code

CodeCast | Medical Billing and Coding Insights ·

2023/12/19

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 […] The post When to use the new SDoH add-on code appeared first on Terry Fletcher Consulting, Inc..

en-US

21:23

7 Elements of a Successful Compliance Program via OIG

CodeCast | Medical Billing and Coding Insights ·

2023/12/12

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 […] The post 7 Elements of a Successful Compliance Program via OIG appeared first on Terry Fletcher Consulting, Inc..

en-US

17:41

Patient History = Medical Necessity

CodeCast | Medical Billing and Coding Insights ·

2023/12/05

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 […] The post Patient History = Medical Necessity appeared first on Terry Fletcher Consulting, Inc..

en-US

17:20

Transitional Care Management Services

CodeCast | Medical Billing and Coding Insights ·

2023/11/28

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 […] The post Transitional Care Management Services appeared first on Terry Fletcher Consulting, Inc..

en-US

13:05

Telehealth CPT 2024 Rules

CodeCast | Medical Billing and Coding Insights ·

2023/11/21

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 […] The post Telehealth CPT 2024 Rules appeared first on Terry Fletcher Consulting, Inc..

en-US

13:50

E/M Leveling with MDM: Right or Wrong?

CodeCast | Medical Billing and Coding Insights ·

2023/11/14

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 […] The post E/M Leveling with MDM: Right or Wrong? appeared first on Terry Fletcher Consulting, Inc..

en-US

15:16

Final Rule 2024 Shared/Split Visit

CodeCast | Medical Billing and Coding Insights ·

2023/11/07

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 […] The post Final Rule 2024 Shared/Split Visit appeared first on Terry Fletcher Consulting, Inc..

en-US

12:24

Top 10 Tuesday Q&A – Halloween Episode

CodeCast | Medical Billing and Coding Insights ·

2023/10/31

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? 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 […] The post Top 10 Tuesday

en-US

16:57

CMS clarifies how to respond to a CERT audit

CodeCast | Medical Billing and Coding Insights ·

2023/10/24

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. […] The post CMS clarifies how to respond to a CERT audit appeared first on Terry Fletcher Consulting, Inc..

en-US

16:29

Is your CDI compromised by dated EMR entries?

CodeCast | Medical Billing and Coding Insights ·

2023/10/17

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 […] The post Is your CDI compromised by dated EMR entries? appeared first on Terry Fletcher Consulting, Inc..

en-US

11:21

A Look ahead to the 2024 CPT codes

CodeCast | Medical Billing and Coding Insights ·

2023/10/10

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. Subscribe and Listen You […] The post A Look ahead to the 2024 CPT codes appeared first on Terry Fletcher Consulting, Inc..

en-US

18:26

Modifier 25

CodeCast | Medical Billing and Coding Insights ·

2023/10/03

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 […] The post Modifier 25 appeared first on Terry Fletcher Consulting, Inc..

en-US

14:04

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

CodeCast | Medical Billing and Coding Insights ·

2023/09/26

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 […] The post Are you blurring the lines on who’s a doctor or a nurse? appeared first on Terry Fletcher Consulting, Inc..

en-US

20:46

Understanding Prior Authorization

CodeCast | Medical Billing and Coding Insights ·

2023/09/19

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. […] The post Understanding Prior Authorization appeared first on Terry Fletcher Consulting, Inc..

en-US

16:46

EM Data Points Confusion Clarifications

CodeCast | Medical Billing and Coding Insights ·

2023/09/12

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..

en-US

17:33

What is the G2211 complexity add-on for 2024?

CodeCast | Medical Billing and Coding Insights ·

2023/09/05

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 […] The post What is the G2211 complexity add-on for 2024? appeared first on Terry Fletcher Consulting, Inc..

en-US

21:57

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

CodeCast | Medical Billing and Coding Insights ·

2023/08/29

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..

en-US

19:45

Waiving Co-Pays and Deductibles

CodeCast | Medical Billing and Coding Insights ·

2023/08/22

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..

en-US

12:45

What’s The Latest Medicare Update?

CodeCast | Medical Billing and Coding Insights ·

2023/08/15

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..

en-US

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CodeCast | Medical Billing and Coding Insights

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