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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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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What are the most common claim denials?

In this episode of the CodeCast Podcast, Terry looks at a recent survey of over 100 medical insurance payers to determine 13 of the most common reasons claims are denied and how practices can eliminate them.

The survey, based on over 100 insurance payers (including Medicare Contractors) reveals reasons which are becoming as routine as submitting a claim!

Using Terry’s recommendations, practices will experience a smoother revenue cycle plus find greater financial success.

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