In this episode of the CodeCast, Terry continues her Top 10 Tuesday series with allergy, orthopedic, 25 modifier, and cardiology questions, plus more.

These responses can impact your workflows along with your understanding of coding concepts. Tune in for a mixed bag of coding questions that have reimbursement complications you don’t want to miss!

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There have been a lot of discussions lately on whether or not Coders are Billers and vice versa.

In the grand scheme of things, what do you want your employer (or potential employer) to consider your role as?

On this episode, Terry discusses the differences and also touches on the current status of the PHE.

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On July 7, 2022, CMS issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues.

Those changes are effective on or after January 1, 2023.

On this episode of the CodeCast podcast, Terry gives us the summary of these changes, the new 2023 Proposed E/M changes, and some new technology Coding updates for Coronary Shockwave Lithotripsy.

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This week’s CodeCast podcast revisits the topic of “Incident to.”

The last time this was covered on the show was back in February 2021. That is well over a year ago! Now with more and more practices hiring NPs and PAs, we need to make sure we know and follow, the rules.

A recent report by MedPac, the commission that reports on Medicare NPP payments, states “Medicare could save over $94 million a year with no incident to.”

This is an important financial impact topic for your practice. You not only need to be compliant but also make sure you are profitable.

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A healthcare practice must verify the patient’s coverage and eligibility for medical services being sought and determine their responsibility for payment.

Through the patient eligibility and benefits verification process, physician practices can confirm the coverage offered by the health plan and share of cost by the patient in the form of co-payments, deductibles, and coinsurance.

With the NSA and Balance Billing limitations in 2022, healthcare providers must collect payments from patients proactively to prevent. delays in practice cash flow.

Terry discusses her top ten tips for success in this process in this episode of the CodeCast Podcast.

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Many payers are starting to put restrictions on payment and submission requirements when billing the 25 modifier on E/M services with minor procedures on the same date.

You will see reductions in payments and new paperwork requirements for submission. Terry tears into the update in this show, plus bonus information on the CPT Errata June 1st, update.

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This week, Terry introduces a new ICD-10-CM topic of HCC (Hierarchical Condition Category) coding relies on ICD-10-CM coding to assign risk scores to patients. Each HCC is mapped to an ICD-10-CM code.

Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurance companies can use a patient’s RAF score to predict costs for sick patients.

Terry also discusses the importance of HCC coding and why the OIG is looking at the accuracy or an FCA could be an issue.

Tune in for all of the details.

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This week on the CodeCast Podcast, Terry Fletcher discusses the differences between the IPPE, AWV and a routine physical exam.

Many providers are billing E/M services to “establish care” and this may not be accurate.

Listen to find out why and how to avoid this common problem.

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In this episode of the CodeCast, Terry continues her Top 10 Tuesday advice on clarifications to the 2021 EM Guidelines for Office and Other Outpatient visits.

There is still a lot of confusion: and with the 2023 rules only months away, we need to figure out how to navigate the newest rules.

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This week Terry’s focus on “coding” looks into add on codes and their descriptors: mainly the three types of add-on codes as described by CMS.

Is there ever a time that an add-on code can stand alone? Maybe!

Tune in this week for this new topic on medical billing coding.

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If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/