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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Episode 15 of the CodeCast Podcast takes the topic of Medical Practice Collections and Appeals to the next level… literally. Terry discusses level 1, 2 and yes, a level 3 appeal, in the process of collecting and protecting your money. Her approach in the appeals process gives insight into a work product that is often negative in the medical industry but makes it a positive project-oriented task.

Claim denials cost the medical industry over $1 million annually. How much of that is coming from your practice? Do you have an appeals process in place?

Claim denials will happen. It’s inevitable. This podcast will discuss working through those challenges with smart solutions to assist in your success in your relationships not only with payers but also with patients, the practice, and the insurance industry as a whole.

It’s time to be a force in the reimbursement process. It’s your money. Protect it!

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Terry continues her theme with medical practices making sure they have done their due diligence to keep their practices healthy, in giving you a checklist for Billing Service Outsourcing. Are you considering outsourcing your billing and coding? Do you have a billing company in mind? What questions do you need to ask to make sure you are making the right decision the first time as to not interrupt your cash flow?

Terry goes into detail with this list, also offering her commentary on why you need to ask certain questions and her insight from when she owned her own billing company for over 20 years. Join us for this important discussion before you hire a company. Be prepared.

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Continuing our discussion of the importance of a practice assessment and checkup, Ms. Fletcher gets into part two of this two-part series, to discuss industry benchmarks, the importance of crunching financial numbers and how to consider the culture in your practice as an invaluable investment in your medical practice’s success.

By learning what inefficient processes, people, and other factors may be holding back your practice, a medical practice assessment can uncover the underlying problems and empower you to make informed decisions: decisions that will position you and your patients for success now and in the years ahead.

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Can you say that you take care of your medical practice health as well as your patient’s health? Isn’t it time for a checkup there as well?

For most provider groups the simple answer is, “yes”.

This week Terry dives into part one of a two-part series to give some serious insight as to the value of regular practice assessments. She will discuss how to stop and focus on the big picture, and really look to take the “business side of medicine to the next level” by giving you five easy steps that can validate if you are on the right track to meet or exceed benchmarks for success as well as for industry or market changes.

Learn some steps and further benefits to help you take a step back and easily and quickly assess your practice in the most pro-active and meaningful way.

Continuing with this month’s theme of revenue and where those sources can come from, Ms. Fletcher discusses the “Hidden Revenue” that already exists within your medical practice, and how coders, billers, administrators, and physicians can tape into these sources. Healthcare regulations continue to focus on ways to reduce costs and increase efficiency for both Providers and Health Plans, with a renewed emphasis on electronic payments. We will discuss the pitfalls of Healthcare Virtual Credit Cards, the benefits of EFT payments, and work through the Coding and Reimbursement challenges of claim denials.

This is a session you won’t want to miss for the financial health of your practice.

Happy New Year listeners. This week Terry rings in 2018 with some revenue opportunity gems, that many physician practices may not realize are billable services. With current reimbursements at a standstill, it is more important than ever to explore what revenue sources are available to physician practices with little or no cost to them to facilitate the service.

We will discuss Behavior Change Intervention codes, MNT codes, as well as home INR testing to name a few. Join us as the reimbursement process, in the Business of Medicine is taken to the next level with our CodeCast Podcast of the week.

This week Terry tackles the topic of current E/M guidelines and how CMS has opened up the lines for current discussions and dialogue to update these very dated services.

With the technological advancements of electronic medical record (EMR) and the administrative burden that goes with the current 1995 and 1997 documentation guidelines, Medicare is aware it’s time to make some changes.

Ms. Fletcher discusses how medical professionals and providers can make an impact on these discussions for change and what is on the horizon. Join us for this important discussion.

Physicians and mid-level providers are having some serious conversations with patients regarding their Advanced Care Planning, meaning the discussion of a serious illness and the next steps that they need to take regarding advanced directives, hospice, skilled nursing, pre and post-death arrangements, etc.

These discussions are now payable under most health insurance plans including Medicare, but you need to be walked through the steps of these important conversations first, then consider the options for coding, billing, and reimbursement. Most practices have been providing this important service for years but have never charged for it. Ms. Fletcher brings you the ACP directives and regulatory insight you need to get started. Join us for this important podcast. It could cost you thousands of dollars in lost revenue if you don’t listen in today.

The past three years has witnessed tremendous growth in the use of computer-assisted coding (CAC) systems. Many hospitals, physician practices, and health systems moved forward with CAC implementation after the ICD-10 rollout continued with delays. According to several, 2017 research reports, the CAC industry is expected to see continued adoption with the overall market rising to $5.1 billion by 2023.

What does this mean for the Coding professional moving to more automated coding? Many Coders recognize the benefits of automated coding systems, however, for the most part, the emotions on this discussion have been negative. In the fact, the perception is that upper management doesn’t understand the complexity of a coder’s job, that “the financial people just don’t get it”. Even though there is some wonder and excitement in response to the new technology, there is still the worry on behalf of coders, that the impact of technology on their job security would suggest the phasing out of a manual coder.

Ms. Fletcher talks through this perception and attempts to put the coder’s fears aside to reassure them that automated coding will not entirely replace coding professionals. Computers should be viewed as another tool to aid in the coding process, increase efficiency, and actually improve coding skills as we move toward these advancements.

Medical scribes can increase efficiency and the quality of chart documentation, and lessen audit exposure in most practices.

Terry discusses using medical scribes in a physician’s practice; how to calculate your ROI (return on investment) if you chose to use a scribe in your practice, and will outline not only their potential duties, but give you insight to what their qualifications should be and then the Joint Commission and CMS’ position and requirements for documentation, signatures, and authentication of their work.

Should you hire a scribe? Listen in to find out.