CodeCast | Medical Billing and Coding Insights

Many practices offer cash payment options to avoid insurance billing, hoping to reduce administrative burden or boost revenue.

However, this practice of charging cash for services that could be billed to and covered by a patient’s insurance plan raises serious compliance concerns. Federal law and insurance contracts generally prohibit this practice because it undermines the healthcare payment system and can lead to regulatory violations.

Terry discusses the compliance ramifications of this policy with a little health from a NAMAS article.

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The post Charging patients cash for “insurance covered” services appeared first on Terry Fletcher Consulting, Inc..

Sometimes there are coding, compliance, and billing questions that we struggle to find answers to in any published guidance or specific regulatory rules.

This week on the CodeCast podcast, Terry brings up three specific questions that we are always hunting for answers to and the best way to deal with them.

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The post Sometimes the rules are as “clear as mud” appeared first on Terry Fletcher Consulting, Inc..

In this episode Terry discusses the importance of ICD-10-CM codes on billing claims. She also clarifies the ICD-10-CM General Guidelines on Borderline Diagnoses, Laterality, Acute versus Chronic Conditions, and when to leave the symptoms off the claim for definitive diagnoses.

Listen in for this important information capture.

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The post Does ICD-10-CM Codes Claim Position Matter? appeared first on Terry Fletcher Consulting, Inc..

CMS released their FAQ sheet for the add-on code HCPCS G2211, to office visits. The sheet clarifies where denials and grey areas for reporting.

Tune in as Terry goes over twelve FAQs from CMS along with her commentary to best practices for this complexity add-on.

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The post G2211 CMS FAQ Sheet Released appeared first on Terry Fletcher Consulting, Inc..

In this episode of the CodeCast podcast, Terry discusses ABI billing, Level 5 Drug Toxicity options, Aortic Stenosis ICD-10-CM coding, and some questions related to the 2025 CMS proposals.

Listen this episode to see if any of your Coding Corner questions made the podcast cut!

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The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..

CMS proposes expanding the transfer of care modifiers, -54, -55, and -56 to better “value” the global surgery CPT codes.

However, this may cause more confusion for surgeons and medical providers who see patients for surgery or post-op only.

Terry talks about the proposal and what to expect for 2025. Also, Terry talks about the proposals for Telehealth.

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The post Transfer of Care Modifiers appeared first on Terry Fletcher Consulting, Inc..

This edition of the CodeCast podcast focuses on coding heart caths. When coding for cardiac catheterizations, if you don’t have a working knowledge of this specialty it can be a bit challenging. That’s why it’s time to get back to the basics.

Terry provides some tips into this coding concept, and what to look for in your report to capture the correct CPT codes.

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The post Coding a Heart Cath appeared first on Terry Fletcher Consulting, Inc..

Terry takes us down memory lane in an E/M refresher. She covers what changed with the CPT E/M section – that was updated in 2019, 2020, and 2021 – to get to what we have today in 2024.

Getting back to basics helps you understand why we must ensure updates in our charting workflows and EMRs continue.

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The post E&M Comparison appeared first on Terry Fletcher Consulting, Inc..

This week on the CodeCast podcast Terry returns with her Top 10 Tuesday Q&A series.

Join us as Terry covers questions covering risk support for E/M, Telehealth in the hospital setting, missed appointments, follow-up testing protocols, shared visit modifiers, and more.

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The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..

CMS published their PFS on July 10th. You have 90 days to comment and be heard on these changes including the proposed 2.93% reduction to the Physician Fee schedule.

In this edition of the CodeCast, Terry goes over the talking points and what Part B providers can expect coming into the new 2025 calendar year.

You don’t want to miss this important episode!

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The post CMS Newsroom Update: Physician Fee Schedule 2025 appeared first on Terry Fletcher Consulting, Inc..