The CodeCast Podcast | Medical Billing & Coding Insights

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

National Speaker and Healthcare Consultant, Auditor and Educator, Terry Fletcher CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, knows from over 25 years medical reimbursement industry experience that Coding, Billing and Compliance for physician practices and hospitals can be tough to navigate. Her CodeCast® Podcast series will share insights to current rules and regulations the Medicare payer requires, along with Commercial insurance plans’ rules and reimbursement challenges. Discover revenue opportunities to maximize reimbursement in your medical practice, focusing on different medical specialties and platforms each episode.

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In this session of the CodeCast Top 10 Tuesday Q&A, Terry tackles a flood of questions and answers focused on practice management:

– Deciding to opt in or opt out of insurance plans
– Should you have a practice website?
– What should be part of that website?
– How the new Medicare Card rollout impacts your practice
– Questions and answers for injection coding
– And much more!

It’s a jam-packed CodeCast this week, with a potpourri of topics to address to continue to “Take Your Business/Practice to the Next Level.”

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In this week’s CodeCast Ms. Fletcher discusses the “art” of negotiating payer contracts. Whether you are a novice or a seasoned negotiator, payer contracts can be complicated.

In order to sustain viable revenue, it is prudent to analyze and effectively negotiate healthcare payer contracts. Today’s discussion turns to “cost analysis” and how to effectively negotiate contracts: not only for peace of mind that your revenue is protected but that your reimbursement also accurately reflects the market and your individual needs as a practice/provider.

Even if a practice is run efficiently, and has low overhead, if payer contracts are not properly negotiated or worded, it can result in a loss of revenue. This is “The Business of Medicine”. It is not personal, but it is your livelihood. That is why you must make sure that there are no payment inequities within your contracts, and that you have the tools to effectively negotiate with your insurance payers.

Join us as we continue to “Take your practice to the next level”.

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Auditing physician’s practices for a living can be a tough job. It’s even tougher witnessing a continuing pattern of behavior in vital documentation with many physicians across the country.

In today’s CodeCast, Terry shares her auditing concerns and issues that have risen out of 1000’s of audits she has conducted over the years.

The discussion centers around the importance of passing or failing an audit, and avoiding being a red-flag to payers but will also show both sides of the process. It’s important to not only focus on documentation and coding failures, but also positive outcomes from a training discussion with the provider. Terry will also talk about tools to make the documentation process easier: think of this as your personal CDI discussion with some revenue opportunities mixed in!

Remember, this is about taking the “Business of Medicine” to the next level.

Your business. Your practice. Your peace of mind.

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This week, Terry discusses the ever confusing topic of “New vs. Established” patient visit.

Billing and coding staff continue to have confusion over the question of “What is a New Patient?” However, it’s not only the billing office that needs clarification but physicians as well. Since new patient visits carry a higher Relative Value Unit (RVU, or “reimbursement”) they are always going to be under the watchful eye of payers.

Those payers are quick to deny any unsubstantiated claims, which means your E/M coding needs to hold up to claims review. Today’s CodeCast will give you the insight and guidelines for review while adding tips for capturing new patient revenue (when appropriate).

Bonus: At the end of the podcast Terry will also give her overview of the CMS listening call from 3/21 and the potential changes coming to the E/M services in 2019 and 2020.

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It’s that time of the month again: it’s Top 10 Tuesday Q&A!

On the last Tuesday of each month, this ongoing series will address the top Coding, Billing and or Compliance questions Terry has received during the month.

Listen in to troubleshoot billing and coding issues with Terry today to make you a more efficient and informed coder, biller, collector or physician. You may not realize you had this question come up in your practice, or maybe you did and now we have the answers!

If you are an OnDemand Coding Corner member through Ms. Fletcher’s service, your questions may be asked and answered on air.

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Today’s topic is Chronic Care Management (CCM) services which are typically provided outside of face-to-face visits who have a least two chronic conditions expected to last at least 12 months. Clinical staff time is used to monitor these patients who are at significant risk of death or acute/exacerbation or functional decline.

This is not only a potential revenue opportunity for work you may already be doing in your practice, but a patient-relationship builder that will allow your practice to have higher satisfaction ratings, fewer re-admissions to hospitals, and overall better patient outcomes.

Chronic Care Management has been approved for payment by Medicare and many 3rd party payers. This payment has specific guidelines of which Terry will offer insight and cover rules and CPT/HCPCS codes on how this all works. She’ll also discuss the ICD-10-CM codes that help support these services and show medical necessity. This revenue source should be a top consideration for implementation as we bring the first quarter of 2018 to a close.

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If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: http://www.terryfletcher.net/contact/

In this week’s episode, Terry assists her listeners in developing a thorough medical audit program which captures the essence of why an audit is necessary to the continued success and future health of a medical practice organization.

This show gives insight on how to start an audit conversation with your provider and some key elements to include in your proposal.

An audit program, whether it be internal or external, can assist practices to not only identify incorrect coding and billing practices, protect against fraudulent claims, and help to identify and correct problem areas of coding and documentation, but it can also bring peace of mind that services are being captured compliantly to maximize physician reimbursement.

Developing the key conversation elements, with specific goal suggestions for a concise audit proposal and outline, will help it get noticed and be taken more seriously.

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If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: http://www.terryfletcher.net/contact/

When you speak to your physicians, you want to carry more weight in your conversation. However, a topic of change may require some finesse on your part.

Today, Terry gives you her best tips to improve your influence on your medical providers, by giving you her insights into the skills coding, auditing, and compliance professionals must have when speaking to medical executives. These “soft skills” are necessary to share your expertise, collaborate with providers, and in many cases, “influence” physicians and other healthcare providers to change behaviors to improve documentation and coding accuracy.

Your physicians have a million other things to do and so do you! Terry will discuss ten tips for success that, among other things, will help you be prepared to get to the point and make an impact.

Remember, your “influence” is not only limited to the conference room or physician’s office: you are marketing yourself in every email, meeting, and in-person discussion in which you contribute. You are ultimately in control of elevating or diminishing your ability to influence others in the workplace.

This episode will help you be that influencer!

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If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: http://www.terryfletcher.net/contact/

Ms. Fletcher shares her responses and insights to some frequently asked questions while assisting coding and billing staff in their coding processes with advice on certain ICD-10-CM codes.

Some of these codes can be tough to navigate through. CPT codes for GI Screening, Pacemaker Device checks, and Transitional Care Management services code choices can be confusing.

Today, Terry takes some of her most frequently asked questions from her onDemand Coding Corner Service Membership to help clear up some of that confusion.

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If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: http://www.terryfletcher.net/contact/

Every practice at one time or another has at some point needed to do without their employed physician on a temporary basis. Whether it be for a sabbatical, vacation, maternity leave or any other reason, physicians do take time off.

When a practice cannot “cover” internally for the physician needing an extended amount of time off, one option is to hire a Locum Tenens physician. When you hire and bill for an LT physician, you are billing for a substitute, or covering physician as if they were the regular physician who is not available.

The following podcast will give you insight on what the experience has been by physicians who have been there, how the experience should be should you are one of your physicians want to take this on, and lastly, as this is a CodeCast, Terry will give you her expertise on the coding process so that you don’t miss a beat when billing for Locum Tenens physician services. (And also how long this can be available to your practice.)

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If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: http://www.terryfletcher.net/contact/