CodeCast | Medical Billing and Coding Insights

When a Medicare beneficiary arrives at a hospital in need of medical or surgical care, the physician or other qualified practitioner must decide whether to admit the beneficiary as an inpatient or treat him or her as an outpatient.

These decisions have significant implications for hospital payment and beneficiary cost sharing.  Not all care provided in a hospital setting is appropriate for inpatient, Part A payment.

Terry discusses the 2-midnight rule, and how that impacts both Part A and Part B providers and patients. There is more to consider than meets the eye.

Terry also covers what CMS recently published in the Final Rule for MA plans.

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The post 2-Midnight Rule and MA plans appeared first on Terry Fletcher Consulting, Inc..

In this week’s episode of the CodeCast podcast Terry discusses collecting information on medical practice websites.

How you collect data on a website is equally as important as the data itself. If a patient doesn’t mention a medical condition, their information may still be considered as PHI.

Terry covers requirements, such as PHE and ePHI access, securing data in an encrypted manner or HIPAA-compliant location, and having a system in place to destroy sensitive data that is no longer needed.

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The post Did you know this is a HIPAA violation? appeared first on Terry Fletcher Consulting, Inc..

Terry discusses how to be accurate in your documentation when picking the low, moderate or high element(s) of MDM.

When listing “problems addressed” in your E/M record, and considering chronic conditions, the definition of a stable, chronic illness, per AMA/CPT states, “stable” to categorize MDM as defined by the specific treatment goals for an individual patient.

A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function. By this definition, a patient might be living with a chronic condition that is controlled.

However, if they are falling short of their treatment goals, they would not be considered “stable.”

This shows that the spirit of the new AMA/CPT E/M Documentation rules are about patient-centered care and that every patient has a unique set of goals and circumstances: achieving these personalized objectives truly determines “stability.”

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The post E/M Services: Stable or Unstable Chronic Conditions? appeared first on Terry Fletcher Consulting, Inc..

CPT says: “If no specific CPT or HCPCS code exists, then the procedure must be reported using an appropriate unlisted CPT code.”

Unlisted CPT codes, when reported with appropriate documentation, should be reimbursed. It is the responsibility of the surgeon, and the coding or billing staff, to report unlisted CPT codes and follow up with payors if a claim is denied.

On this episode of the CodeCast Podcast, Terry Fletcher will dive into this topic to help you with successful unlisted procedure claims.

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The post Coding and Billing The “Unlisted Code” appeared first on Terry Fletcher Consulting, Inc..

Join Terry Fletcher on this week’s CodeCast as her Top 10 Tuesday returns. Terry has a packed podcast as she answers questions about G2211, 99459, and new versus established patients.

This is one episode you don’t want to miss for insights and resources to your most important coding, billing, and compliance questions.

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

Did you know there are CPT codes for online digital E/M services? CPT codes 99421-99423 are for use by physicians, physician assistants, and advanced practice nurse practitioners performing brief online E/M services via a secure platform. (Like a patient portal.)

What is required to bill for these services? Consent? Interactive Conversation? Modifiers? POS? And what is CBTS?

Tune in as Terry discusses this topic, and more, to find out if this revenue opportunity and patient value-added service is something you should report.

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The post Reporting eVisits 99421-99423 appeared first on Terry Fletcher Consulting, Inc..

We have received questions left and right regarding the new Medicare add-on code +G2211 – for complexity and serious condition provider/patient long-term relationship care.

We discussed this code in September 2023, when it was a CMS proposal, but now that it is effective let’s look at the realities. The Modifier -25, when reported on an E/M claim with the G2211 will be denied.

But what about the NCCI edits when you can’t avoid the 25 modifier, such as adding, immunizations or preventative services? Will you still see denials of the G2211? Can NPP’s report this add-on? What conditions can be considered? What providers and specialties can report this code?

Tune in this week as Terry provides some answers to these questions and more.

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The post Revisiting the G2211 in 2024 appeared first on Terry Fletcher Consulting, Inc..

This episode of the CodeCast is sponsored by DecisionHealth LLC, Part B News.

The PHE, public health emergency, ended on May 11th, 2023. However, the confusion on reporting Telehealth services continues. It is imperative to be up-to-date on all of the current published guidance.

In this episode, Terry shares her Telehealth services tips and checklist that will help you stay compliant (primarily for Medicare) in 2024. Terry discusses changes that will impact all medical practices engaged in using Telehealth for many of their office visit and hospital visit encounters.

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The post 2024 Telehealth Checklist appeared first on Terry Fletcher Consulting, Inc..

*** CORRECTED AUDIO ***

The generative artificial intelligence (also known as “AI”) boom is in full swing now. Terry has been researching AI in healthcare: some people are thrilled with it, while others are not.

Is scraping the web for training data ethical? Who decides whether AI documentation and “expertise” is any good? How should copyright law apply to AI-generated work? Where is the oversight to deter biases and hallucinations?

In this episode, Terry illustrates the resistance to using AI and asks tough questions to advocate for safeguards to make sure technological progress doesn’t destroy the healthcare industry.  Everyone needs to understand what’s at stake, other than a future envisioned by Big Tech.

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The post Concerns About AI in Healthcare for 2024 appeared first on Terry Fletcher Consulting, Inc..