CodeCast | Medical Billing and Coding Insights

Terry discusses when it is and isn’t appropriate to report a preventative visit with an office visit on the same date.

How did the patient present? What is the share of the cost-to-patient implications? And what will payers want to see for medical necessity?

Terry covers it all in this edition of CodeCast podcast.

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In today’s episode of the CodeCast podcast, Terry updates you on the latest CMS NCCI Edits, effective July 1st. She gives you the insight on the PTP and MUEs expected, along with some commentary and best practices on charging patients for no-show appointments.

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The post NCCI Updates 30.2 and No Show Appointments appeared first on Terry Fletcher Consulting, Inc..

Principal Care Management (PCM) services are services for a single high-risk disease, 30 minutes a month, personally provided by a physician or NPP. This is for patients with one complex chronic condition expected to last three months which places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death.

Does your patient qualify? Terry covers the details on documentation requirements (on CPT page 55) and its importance for compliance.

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Can you guess the main reason why medical billing claims are rejected? According to recent studies, most clinics account for 15-25% of inaccurately submitted monthly claims. Those inaccuracies must be corrected, resulting in an annual loss of revenue worth tens of thousands of dollars.

Among the most popular reasons medical claims return to a clinic are due to incorrectly entered or missing information. When a clinic is unable to bill the insurance company properly, a rejected claim or frequent denials can put you in a position to provide an unexpected bill to the patient.

Too much confusion around the billing process can discourage patients from visiting your clinic or, much worse, make them put off necessary treatments.

In this episode, Terry discusses the top ten coding and billing mistakes and how to lessen those errors for successful claim submission.

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The post Top 10 Coding and Billing Mistakes – Let’s Fix It! appeared first on Terry Fletcher Consulting, Inc..

You must make sure your providers and coders understand the overarching LCD criteria for reporting TPIs (Trigger Point Injections).

As of April 1st, five MACs have tightened their rules for TPI coding and reporting. There are new frequencies, ICD-10-CM, anatomical territories, and MUE rules for these services.

Terry outlines the rules and reminds practices that patients need to also be involved in these discussions.

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The post Trigger Point Injections and LCDs appeared first on Terry Fletcher Consulting, Inc..

How do you know if your role is classified as a Coder or a Biller? Coders typically work in the back end of the facility, focused on interpreting medical records and assigning appropriate codes. Billers interact directly with patients, collecting payments and entering patient information into the appropriate systems.

However, there is also a crossover between the two roles!

Terry discusses that intersect today in her 346th episode of the CodeCast podcast.

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The post Are you a Coder or a Biller? appeared first on Terry Fletcher Consulting, Inc..

All CPT codes have an expected range of complexity and uses, but when a particular procedure or surgery performed has exceeded the normal range of complexity, modifier -22 can come into play. Modifier -22 is defined as increased procedural services and demonstrates when a physician has gone above and beyond the typical framework of a particular procedure.

When used appropriately, modifier 22 reimburses the physician for unforeseen difficulties or additional time spent that are not usually anticipated for the procedure. However, as most coding staff know, it takes some savvy coding and insight for proper reimbursement, and will take more than simply attaching a modifier to a service code if your provider is to be compensated accordingly. Terry discusses how to be successful when using the 22 modifier.

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The post When To Use The -22 Modifier 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 from Urgent Care to the ER, infusion charges, behavioral health, billing for unlisted codes, preventative med group codes, 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..

Are you a “Subject Matter Expert?” Are you taking on clients, presenting to physicians, or looking for a coding job: with no expertise?

Do not “wing it” in the healthcare field. You will hurt yourself or your credibility unless you disclose your limitations to the person you are doing business with. (Not to mention potentially hurting the physician, client, or practice.)

Terry discusses this problem and how to overcome it in this episode of the CodeCast podcast.

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Many of the records Terry audits include a disclaimer to protect a physician from liability. However, does this disclaimer shield a physician who has signed a note or authenticated an electronic encounter? (Under the assumption the physician reviewed it?)

In this episode of the CodeCast podcast, Terry discusses the protections of a disclaimer and whether this evades the responsibility, and compliance, of documentation.

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The post Is a Medical Record “Errors Disclaimer” Valid? appeared first on Terry Fletcher Consulting, Inc..