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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Interoperability refers to the basic ability of computerized systems to connect and communicate with one another readily: even if they were developed by widely different manufacturers in different industries.

Being able to exchange information between applications, databases, and other computer systems is crucial for the modern economy and healthcare today. But is this HIPAA compliant?

Terry shares her insight on this matter, as well as authoritative references, so you can make sure you are above reproach as technology moves healthcare forward.

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There are many similarities between the two models of Concierge Medicine and DPC (Direct Primary Care).

While the differences are basic: but, in my opinion, they can make or break a physician’s practice if you are not clear on how it works. You must learn how to follow the letter of the law and how to comply with Medicare.

Today’s podcast will compare and contrast the two practice models and conclude with a few thoughts on how (or if) you are ready to engage in this type of practice.

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The AMA Editorial Panel made a final ruling to overhaul the entire E/M section of CPT: and Medicare is on board with these changes.

History and Exam may no longer factor in scoring a level of services, and the definition of medical decision making will be revised. “Time” will be a factor in choosing most codes as well as add on codes for time.

Join Terry to navigate through these confusing waters of the ever-changing E/M Documentation Guidelines, which are effective January 2021.

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Terry gets creative with her Top 10 Tuesday this week, and brings to you “The Coder’s Top 10 Pet Peeves”. Pet peeves are minor annoyances that can cause major irritation, and she has a list specific to healthcare professionals!

However, pet peeves aren’t just “complaining”: they are an “out-of-the-box” form of communication. Rather than treat pet peeves as irritants that we cannot address, we should think of them as problems that can be solved.

As you’ll hear on this episode, Terry’s list, gathered from her years of experience as well as coders around the world, will, provide ways to improve productivity and employee satisfaction… even with a little humor added!

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To achieved the highest bonus threshold using the 2019 rule for the Quality Payment Program (QPP – also known as MACRA) there are eight objectives physicians need to know.

In this episode of the CodeCast podcast Terry Fletcher talks about these eight guidelines as well as why patient satisfaction surveys should be implemented into your practice so you can learn what patients are saying. You can then get your staff on board with the results!

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Medicare does not treat all surgeries the same. An inpatient-only surgery list is released every year by CMS. These procedures are automatically approved for Part A coverage and must be performed in a hospital. All other surgeries, as long as there are no complications, are covered by Part B.

CMS also releases an annual Addendum AA that specifies what outpatient (i.e. not inpatient-only) procedures can be performed in Ambulatory Surgery Centers. All remaining outpatient surgeries must be performed in a hospital for anyone on Medicare.

Find out which group your procedure falls into ahead of time so that you can better plan for it and avoid additional stress. Today’s episode will help us tackle error resolutions together.

Also, Terry will review X-Modifier information for revenue integrity!

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A hot button topic that needs to be discussed is the the waiving of deductibles, copays, and any patient share of cost. It is becoming a problem in medical practices and leading us back into that legal blackhole of the 80’s.

Terry is opting to take the heat and have a heart-to-heart with you on this show about standing up to your physicians, practice administrators, and anyone who is in charge of revenue integrity: and have them listen to this podcast… today!

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Terry returns with February’s top ten coding, billing, and reimbursement questions.

In this a mixed bag of coding questions and answers, Terry discusses the MIPS bonus incentive payments, how to make sure your skin lesion diagnoses are accurate, and when to capture moderate vs. monitored sedation with procedures.

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Is your EHR claiming they are certified? You need to check!

Current claims settlements are growing. Therefore, you must check to make sure your software is representing the capabilities of your EHR product correctly… or you could find yourself in hot water.

Terry will also address mystery services that have you saying: “I can code for that?” Yes, you can!

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This episode of the CodeCast podcast focuses on YOU!

Terry combines clinical definitions along with the coding aspect of medical billing in a unique way which will help you increase your credibility while positioning you as an expert healthcare professional.

Stick around as Terry also covers migraine headaches, heart cath with PCI’s, and unused drugs in this episode.

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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/