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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Were you aware that there are codes for falling from an apple tree, injuries occurring during a football game or getting hurt performing household chores?

Terry covers these codes and clarifies the difference between Supervision Guidelines and Incident To, as confusion between the two is causing a lot of non-compliance issues which could lead to refunds.

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Effective November 4th, 2019, the Federal Register posted that CMS has new authority to revoke physicians’ billing and reporting privileges if they find that they have any direct or indirect affiliation with other providers, or entities that have had their privileges revoked in the past or if they have past due money due the government.

Also, the new billing rules for Advanced Diagnostics will cause many offices to change their processes in how to get approval and report these services.

Check out the latest CodeCast as Terry Fletcher reveals all of this week’s breaking news.

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In this month’s Top Ten Tuesday episode, Terry dives into coding questions regarding SDOH and HCC capture, along with the new ICD-10-CM for vaping injuries.

Also on this broadcast is the discussion of patient portals and how HIPAA protected are they really?

This is an information-packed episode you do not want to miss!

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There are many ways in which mid-level provider visits can violate the incident-to rules. Without an audit, your Medicare carrier won’t know that the rules have been violated since a claim for an incident-to service looks exactly like a claim from the supervising provider. However, audits are triggered when CMS sees a significant number of services for a single physician because both the provider and the APP are billing under the physician’s National Provider Identifier (NPI).

CMS is frustrated with the continued non-compliance in this area. Listen in this week, as Terry clarifies the rules, regulations, and how to be audit-proof when reporting Advanced Practice Providers services under the incident to billing rule.

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This week Terry spotlights the 22-modifier in claims that need an extra reimbursement from an “Increased Procedural Service”.

She will give you tips on how to be successful in the use of the 22-modifier, along with some insight on how to show your credibility with payers.

Also, Terry discusses how to deal with information overload when returning from a conference.

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ICD-10-CM introduced new concepts that were both straightforward, and confusing.

One concept that is often debated is how to select the correct 7th digit character, which represents the episode of care. (This term is applicable to most injuries, poisonings, and other external causes.)

Terry explores this concept and shows you how to tell the complete patient clinical story through this 7th digit.

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Did you know Prescription Drug Management MUST include an actual prescription?

There is a constant struggle to explain to physicians that providing a “script” to a patient does not always qualify your E/M service as a level 4. We need to do away with that myth and focus on what PDM really means to Medical Decision Making, and how MDM contributes to code level choices.

If there is no prescription given, then where is the management?

Terry will give you the insight on this topic to make sure you are compliant in your coding and documentation efforts.

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Terry discusses the need for coding audits on the staff; to ensure quality along with good production efforts.

What is being looked at in these audits? And how it can help healthcare professionals grow in their job to reach a high standard of job performance?

Terry will talk about these topics, as well as conflicts with coders and administrators, and how to rise above those situations.

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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/

In the latest edition of the CodeCast Top 10 Tuesday, the “Modifier Spotlight” series returns.

On this edition, Terry will focus on Modifiers, 51, 52 and 53: appropriate use, best practices for reimbursement, and the pitfalls of assigning them to the wrong CPT code.

Terry also covers how to understand coding for “easy bruising” under ICD10CM.

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There are 6 after-hours/special services codes in the Special Service, Procedures, and Reports section of CPT. Four of these codes tend to present a challenge for coders because the vagueness of the guidelines or the inexplicit code descriptors leave coders wondering: “Can we charge for these?”

Terry gives some examples and guidance on if and when you can code for these adjunct codes and which payers may be open to paying for them.

She also covers a special report on the top EHR systems physicians prefer.

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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/