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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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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Sometimes as coders and billers we tend to look at a report and think, “Well, what my physician meant to say was…”

We then code from that assumption… and there is nothing more dangerous than assumptive coding!

Yet, it happens all of the time, especially when a coder gets comfortable in their job or with their physician’s documentation.

Terry looks at specific language in today’s CodeCast and asks: “Can we code for it? Yes, or No?”

You will be the judge on this one as Terry expertly gives you the answers on when you are right, and also when you are wrong.

As an added bonus, Terry also leads a discussion on how to “ace” the modifier-59 coding.

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Transitional Care Management (TCM) is increasing in its utilization and billing… but are you doing it right? Is your patient eligible? It is worth the administrative work versus the revenue generated?

Tune in to the CodeCast this week as Terry answers these questions and more. Plus, there’s a bonus discussion on finding your professional bliss.

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Among one of the most popular questions Terry receives is about reducing prior authorization hassles.

Primary care providers and specialty physicians alike rank prior authorizations as one of the greatest frustrations in clinical practice. Aimed at reducing unnecessary or unwarranted spending, the practice of requiring prior authorizations has been blamed by clinicians for delaying or preventing needed care and adding yet another layer of administrative burden to the practice of medicine.

Terry shares 10 proven tricks of the trade to help pare back this burden in your practice and get to the business of taking care of patients.

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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/