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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Are your physicians asking you to “Patient here to establish care” and trying to bill this as a Level 5 visit…  when it is actually Preventative Services?

Terry clarifies the difference between Preventative Services and EM Problem-oriented Services.

She also discusses the billing of both services and the patient share of cost impact, as well as a rant about sleep deprivation. (Are you experiencing it?)

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There are ways to represent professionalism: but what does it really mean to you?

On today’s episode, Terry discusses ways to be inspired on the job to best show professionalism in a Healthcare environment. Her tips will help you feel inspired at your job, but she also goes the extra distance to discuss how professionalism can be perceived by the way patients view your office. What are some of the tell-tale signs that a practice may need a makeover?

Those signs fall into three broad categories: space, appearance, and productivity.

Terry discusses how to identify if your practice is costing you patients simply from a design and workflow situation, and how to fix it.

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Despite the increased resources and references for critical care billing, critical care reporting issues persist.

Medicare data analysis continues to identify 99291 as high risk for claim payment errors, perpetuating prepayment claim edits for outlier utilization and location discrepancies.

In this episode, Terry tackles this topic with documentation recommendations to keep you audit-proof with tips for how to code these high ticket items.

Also, do you know what the ICD-10-CM code X34.XXXA is?

Yep… there is an earthquake in there somewhere!

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Use care when using “time” to support an E/M service: The Documentation Guidelines are clear that there are History, Exam and MDM elements necessary to support each level of service.

However: “…when counseling and/or coordination of care dominates (more than 50%) of the encounter with the patient and/or family (face-to-face time in the office or other outpatient setting or hospital) then time shall be considered the key or controlling factor to qualify for a particular level of service.”

Not all situations will allow for this exception, and certain situations need to be clarified for appropriateness. Can you pass an audit if you use time?

Terry will also discuss your documentation evidence that a counseling and/or discussion was had with the patient.

Plus, a bonus topic: Are your patients having you dropped from your commercial contracts? Listen in to find out.

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In this latest Q&A, Terry gives advice on how to email like a boss and own your job in healthcare.

Also, Terry talks about the new wave of AI (Artificial Intelligence) and how no one is talking about the potential pitfalls on relying on technology without the “human factor” in healthcare algorithms.

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The AMA has published the 2021 E/M changes that they intend to make in 2021. We’ve seen when Medicare and CPT do not agree on how to report a specific service, or group of services, Medicare may produce a HCPCS code(s) with specific guidance for Medicare-contracted providers to follow.

In this breaking news segment, Terry discusses the final changes, how it will impact your practice, when to start training, and how your “clinical team” factors into all of this.

Also, Warafin (anticoagulant management) is the coding topic of the day, with details on the why a patient takes it, why they need to be monitored, and how to code for it.

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The practice of cloned (or copy and pasted) documentation is a significant issue in the use of Electronic Health Records (EHRs). AMA found in a recent study that only 18% of medical records documentation was newly entered.

Terry discusses how the use of cloned notations and documentation can damage the integrity and trustworthiness of a medical record: and also that of a physician.

The growing abuse of this practice or “EHR feature” is an area of government audit focus. We need to act on how this can affect the safety and quality of care for patients, as well as the potential for fraud and abuse allegations.

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Arguably the most important of the three key components of E/M Coding, the Medical Decision-Making ( MDM ) reflects the intensity of the cognitive labor performed by the physician. There are four levels of MDM of incrementally increasing complexity. Terry navigates you through the process, identifying errors that can lead to over and under coding, but also non-compliance.
Terry also discusses the newest ICD-11 diagnosis of “burnout”. Yes, it is a real diagnosis now.

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In the latest Top 10 Tuesday, Terry discusses the top things you must have for your medical billing software to be efficient, effective, and generate revenue success.

Terry also shares her top 5 coding questions this month, including Trigger Point Injections, ICD-10 coding for shin splints, and more.

Join us for an episode packed full of healthcare information you won’t want to miss.

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Do you have “burning” E/M questions that you can’t get a straight answer to?

Terry covers many of those “burning” topics in today’s episode, such as:

  • Can I use HPI elements for my ROS scoring?
  • Can I get a point if I order an EKG and read the EKG?
  • What if the patient is just seen for follow up chronic conditions and how do we report that in the history?
  • And more!

Terry also revisits the consult versus new patient visit for payer plans still using those codes.

Hopefully this episode of the CodeCast finally gets your questions answered!

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