Terry kicks off 2026 by clearing up a major misunderstanding in the provider and manufacturer community. Some believed that CMS’s last‑minute withdrawal of the LCD for skin substitute products would delay or stop the 2026 reimbursement changes.

That’s not the case. The LCD withdrawal has no impact on the Final Rule, and the new 2026 reimbursement methodology for skin substitutes will move forward exactly as finalized, using an incident‑to payment structure.

In this episode, Terry breaks down the difference between the policy halt and the reimbursement rules, and explains what providers need to know about the updated approach to skin substitutes and skin graft products and services.

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The post Skin Substitutes and Grafts LCD vs Reimbursement 2026 appeared first on Terry Fletcher Consulting, Inc..

Terry closes out the year with a deep dive into Medicare’s newly permanent “Virtual Supervision” rule taking effect in 2026, along with a refresher on the current requirements for reporting services under a physician’s NPI versus an NPP’s NPI.

She urges listeners to approach this shift carefully, outlining the risks tied to non‑compliance, malpractice exposure, and whether patient‑safety concerns outweigh any potential financial upside. Tune in to get the context you need before jumping into this virtual model.

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The post Is Virtual Supervision a Good Idea for 2026? appeared first on Terry Fletcher Consulting, Inc..

2026 is coming in fast, and with it comes a fresh wave of CPT code changes that every healthcare professional needs to be ready for.

On today’s episode of the CodeCast podcast, we break down the newest updates impacting Cardiology, Peripheral Vascular services, and several other key specialties.

From what’s changing to why it matters, we’ll walk through the revisions, additions, and potential pitfalls so you can stay compliant and ahead of the curve as the new year approaches.

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The post 2026 CPT Code Changes Are Coming Fast appeared first on Terry Fletcher Consulting, Inc..

Auditing split/shared encounters can become confusing when providers, auditors, and coders are not aligned. CPT and CMS have both issued guidance to help clarify how these services should be billed.

In this episode of the CodeCast podcast, Terry breaks down where to begin when auditing and educating on Split/Shared visits, what payers are currently saying, and how to maintain compliance for physicians and NPPs to prevent payer audits or confidently address them when they occur.

She also gives a shout out to Sonda Kunzi, CPC, for her NAMAS article referenced during the discussion.

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When auditing risk of management in an E/M note, how are over-the-counter (OTC) medications scored? Under the 1995/1997 guidelines, they were categorized in the “low” risk row. However, the 2021 guidelines provide no examples under minimal or low risk, relying instead on AMA and Medicare guidance. Terry explains this distinction and highlights the difference between an acute uncomplicated illness and an acute illness with systemic symptoms. Take a listen.

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The post “Risk” E/M Element OTC Medications appeared first on Terry Fletcher Consulting, Inc..

Medical record signatures are more than the macro “electronically signed by Dr. Jack Jones.” A provider’s signature is a legal attestation that the physician or provider performed, reviewed, and/or agreed with the documentation. Is this actually true, or are your EMR auto-signatures taking over?

Terry discusses this critical aspect of medical record documentation compliance, with a shout-out to NAMAS for an article that also addresses the topic. Plus, a bonus update on the G0136 add-on code for 2026.

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The post MR Signature Compliance appeared first on Terry Fletcher Consulting, Inc..

Across the country, commercial payers are quietly down-coding E/M services without issuing ADRs and without providing notice. Office visit reimbursements are being arbitrarily reduced based on payer algorithms rather than a proper review of documentation for compliance.

In today’s CodeCast episode, Terry sheds light on this growing problem and explains how to take proactive steps to not only challenge it but also prepare for it.

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The post Watch for Payer Automatic Down-Coding Without Notice appeared first on Terry Fletcher Consulting, Inc..

When auditing a medical record, a common mistake is viewing it solely from a coding perspective rather than an auditing perspective. True auditing requires examining not just the encounter itself, but also what occurred before, after, and around it.

Focusing only on coding can result in missed compliance elements and insufficient support for what was—or will be—billed, potentially triggering a formal payer audit.

Terry breaks this all down in today’s episode of the CodeCast podcast.

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The post Auditing a record isn’t the same as coding it appeared first on Terry Fletcher Consulting, Inc..

The September 2025 issue of CPT® Assistant raised important questions about how to appropriately level an evaluation and management (E/M) encounter when the presenting problem is an acute, uncomplicated illness or injury. A growing number of providers have been assigning Level 4 codes simply because an antibiotic was prescribed.

However, this approach may not be accurate when considering the full scope of the encounter and its required documentation elements.

Terry examines this trend and explains why many payers have responded by implementing automatic down-coding policies to address potential overcoding.

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The post Leveling a Visit for an Acute Uncomplicated Illness appeared first on Terry Fletcher Consulting, Inc..

Medical billing and coding encompasses a wide range of responsibilities—from patient registration and claim reimbursement to final payment delivery to the provider. Navigating this process requires close collaboration among billers, coders, insurance companies, patients, and various healthcare professionals.

Although often grouped together as a single discipline, billing and coding are distinct roles that work in tandem to support the healthcare revenue cycle. If you’re considering a career in medical billing and coding, it’s essential to understand that these are separate professions, each demanding unique skills and personality traits. Terry breaks down the individual roles and how they work together to keep the system running smoothly.

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The post Claim Denials: Coding Mistake or Billing Oversight? appeared first on Terry Fletcher Consulting, Inc..