Codecast | Medical Billing And Coding Insights

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 […] 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. Subscribe and Listen You […] 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. Subscribe and Listen You can subscribe to our […] 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. Subscribe and Listen You can subscribe to our podcasts via: […] The post G2211 CMS FAQ Sheet Released appeared first on Terry Fletcher Consulting, Inc..

In this episode of the CodeCast podcast, Terry discusses ABI billing, Level 5 Drug Toxicity options, Aortic Stenosis ICD-10-CM coding, and some questions related to the 2025 CMS proposals. Listen this episode to see if any of your Coding Corner questions made the podcast cut! 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..

CMS proposes expanding the transfer of care modifiers, -54, -55, and -56 to better “value” the global surgery CPT codes. However, this may cause more confusion for surgeons and medical providers who see patients for surgery or post-op only. Terry talks about the proposal and what to expect for 2025. Also, Terry talks about the […] The post Transfer of Care Modifiers appeared first on Terry Fletcher Consulting, Inc..

This edition of the CodeCast podcast focuses on coding heart caths. When coding for cardiac catheterizations, if you don’t have a working knowledge of this specialty it can be a bit challenging. That’s why it’s time to get back to the basics. Terry provides some tips into this coding concept, and what to look for […] The post Coding a Heart Cath appeared first on Terry Fletcher Consulting, Inc..

Terry takes us down memory lane in an E/M refresher. She covers what changed with the CPT E/M section – that was updated in 2019, 2020, and 2021 – to get to what we have today in 2024. Getting back to basics helps you understand why we must ensure updates in our charting workflows and […] The post E&M Comparison appeared first on Terry Fletcher Consulting, Inc..

This week on the CodeCast podcast Terry returns with her Top 10 Tuesday Q&A series. Join us as Terry covers questions covering risk support for E/M, Telehealth in the hospital setting, missed appointments, follow-up testing protocols, shared visit modifiers, and more. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify […] The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..

CMS published their PFS on July 10th. You have 90 days to comment and be heard on these changes including the proposed 2.93% reduction to the Physician Fee schedule. In this edition of the CodeCast, Terry goes over the talking points and what Part B providers can expect coming into the new 2025 calendar year. […] The post CMS Newsroom Update: Physician Fee Schedule 2025 appeared first on Terry Fletcher Consulting, Inc..

Terry discusses when it is and isn’t appropriate to report a preventative visit with an office visit on the same date. How did the patient present? What is the share of the cost-to-patient implications? And what will payers want to see for medical necessity? Terry covers it all in this edition of CodeCast podcast. Subscribe […] The post Office Visit with Preventative Med 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. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts […] The post NCCI Updates 30.2 and No Show Appointments appeared first on Terry Fletcher Consulting, 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 […] 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 […] 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 […] 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 […] 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 […] The post When To Use The -22 Modifier appeared first on Terry Fletcher Consulting, Inc..

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

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

Many of the records Terry audits include a disclaimer to protect a physician from liability. However, does this disclaimer shield a physician who has signed a note or authenticated an electronic encounter? (Under the assumption the physician reviewed it?) In this episode of the CodeCast podcast, Terry discusses the protections of a disclaimer and whether this […] The post Is a Medical Record “Errors Disclaimer” Valid? appeared first on Terry Fletcher Consulting, Inc..