CodeCast | Medical Billing and Coding Insights

Clinical Documentation Integrity, or CID, is important. Outdated information, or information that doesn’t make sense for that date of service encounter, brings into question the reliability of the entire patient record.

Have you updated the language to fit with the current times?

Terry shares a few examples of issues that can raise red flags during an audit.

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The post Is your CDI compromised by dated EMR entries? appeared first on Terry Fletcher Consulting, Inc..

The 2024 CPT codes have been released. Terry briefly looks at the additions, revisions, and deletions and what the E/M code descriptors are revising.

Terry will also offer her last clarification into MNT coding since there continues to be a push to report these codes when the diagnosis is not covered.

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The post A Look ahead to the 2024 CPT codes appeared first on Terry Fletcher Consulting, Inc..

The CPT definition of a significant, separately identifiable service relies on determining the correct level of E/M service to be reported.

Terry discusses what questions should be asked before you determine whether an E/M service justifies the use of modifier 25 according to CPT guidelines, CMS rules, and payer policy language.

Also, this episode’s coding question is a reminder of how to use the TCM rules.

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The post Modifier 25 appeared first on Terry Fletcher Consulting, Inc..

Physicians are educated and trained more extensively than any other healthcare professional. A misrepresentation of a practitioner’s level of licensing, i.e., using the clinical term “doctor” when there is no MD or DO behind the term, is not only misleading but can jeopardize patient safety, expectations and outcomes.

Terry dives into this controversial topic, stating where the blurred lines are and the importance of staying in our respective lanes.

Also, this episode’s coding question focuses on the new patient visit 99205.

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The post Are you blurring the lines on who’s a doctor or a nurse? appeared first on Terry Fletcher Consulting, Inc..

Prior authorization in health care is a requirement that a healthcare provider gets approval from an insurance plan before prescribing their patient medication or doing a medical procedure. Insurance providers use prior authorization to make sure that a specific medical service is needed and worth the cost, and that no duplicative services are being performed.

Payers use prior authorization as a way to keep healthcare costs in check. Terry discusses the Medicare, Medicare Advantage, and Commercial Plan terms with PAs and how to make it administratively manageable. Also, a coding question on Smoking Cessation.

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The post Understanding Prior Authorization appeared first on Terry Fletcher Consulting, Inc..

The AMA MDM directions when leveling an E/M (Evaluation and Management) code (also known as office and/or hospital visits) are still confusing many providers, coders and auditors.

In this week’s CodeCast podcast, Terry attempts to bring some clarity into the Data Points discussion, regarding independent interpretations versus reviewed note.

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The post EM Data Points Confusion Clarifications appeared first on Terry Fletcher Consulting, Inc..

In 2024, there will be a new add-on code for Medicare. This is a complexity code for specific long-term patients, where the provider is taking the treatment journey with the patient, in a longitudinal way.

Terry goes over what the Federal Register proposal is, and who cannot consider this code in 2024. There is a lot to unwrap here.

Terry also covers a bonus payer announcement that will impact many contracts. Tune in for these important details!

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The post What is the G2211 complexity add-on for 2024? appeared first on Terry Fletcher Consulting, Inc..

In this week’s CodeCast podcast, Terry discusses the top ten coding, billing, and compliance questions from the last month.

In this information-filled episode, she covers coding for staff prolonged services codes, how a physician order must be documented, what constitutes critical care coding, 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..

Providers sometimes waive patients’ cost‐sharing amounts (e.g., copays or deductibles) as an accommodation to the patient. However, doing so may violate fraud and abuse laws and/or payor contracts. From a payor’s perspective, waiving cost‐sharing amounts creates two problems.

First, payors often contract with providers to pay based in part on the provider’s usual charges. The OIG has argued that a provider who routinely waives copays is misrepresenting its actual charges.

Second, payors require copays to discourage overutilization and reduce costs. Accordingly, federal and state laws as well as payor contracts generally prohibit waiving cost‐sharing absent genuine financial hardship.

Terry discusses the ins and outs of these policies and how to handle them in your practices.

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The post Waiving Co-Pays and Deductibles appeared first on Terry Fletcher Consulting, Inc..

Medicare has been making some under-the-radar updates that provider practices need to know. You could be seeing ineligible patients, with no current ID card, coming in for services. You could also see denials if you’re not careful.

Terry updates some of the latest postings by CMS so that we are all on top of the information flow.

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The post What’s The Latest Medicare Update? appeared first on Terry Fletcher Consulting, Inc..