CodeCast | Medical Billing and Coding Insights

OIG is to Audit Medicare Payments for COVID-19 Discharges to determine, and investigate, whether hospitals billed for the 20% add-on Medicare payment for COVID-19 discharges correctly.

OIG’s work plan now states that a positive lab test has to be found within the documentation for all patients admitted and discharged after September 1st, 2020 to qualify for the 20% bump in payment.

Terry discusses the details of this audit, plus the specimen and handling code 99000: and is it billable?

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Many commercial payers voluntarily waived all deductibles, co-pays, and other costs for insured patients who fell sick with COVID-19. Many of these patients were hospitalized and needed intensive care, doctor visits, medications, or other treatments.

Setting aside those fees was a good move from a public relations standpoint. The industry got credit for helping customers during tough times. And it had political and financial benefits for insurers, too. But nothing lasts forever.

Starting at the end of last year, and continuing through the first quarter of 2021, many insurers are quietly ending those fee waivers for COVID treatment and patients are finding out after the fact. Terry discusses how to be proactive in making sure you and your patients are informed and why this will be the theme of 2021.

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We all know that Medicare has their definition of “Medical Necessity” under Title 18 of the Social Security Act.

But did you know that the AMA, The American College of Medical Quality, AAFP, and many Payer Contracts have their own defined language of what “Medical Necessity” means?

This week Terry discusses all of them to make sure that you are clear, legal, and compliant when submitting claims for services for your patients. You want to be right the first time!

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Terry discusses the recent CMS alerts and new coding questions relating to the 2021 EM Rules.

Medical Decision Making has everyone confused.

Can vaccines and immunizations be considered in the management of a patient? Where does a pre-op visit for surgery fall in the presenting problems addressed?

Terry discusses these topics and more in this episode of the CodeCast podcast.

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You can subscribe to our podcasts via:

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This week’s CodeCast focuses on the 21st Century Cures Act or the “Information Blocking” regulations.

The regulation became effective last Monday, April 5th, so you must know what is necessary when a patient requests their records and how you could get into monetary trouble if not compliant with their request.

Also, when coding for Atherosclerotic Heart Disease, be alert to the details when you choose an ICD-10-CM code.

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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/

March Madness wasn’t only about college basketball! Medicare made the first quarter of 2021 all about announcements.

Listen to this week’s episode as Terry runs down the new CMS/Medicare announcements, regulation effective dates, and the AAP repayment start.

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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/

We are working so many hours since the pandemic hit in January 2020.

Over a year into the COVID Public Health Emergency, healthcare professionals, like other employees, had to emergently pivot to working remotely. This has blurred the boundaries between work and home.

Let’s talk about how to “Zoom” out our Fridays with Terry this week as she talks about your mental weariness and how to refresh and refocus.

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Every year CMS releases an updated inpatient-only surgery list: and the surgeries on this list are not arbitrarily selected.

Due to the complexity of the procedure, the risk for complications, the need for post-operative monitoring, and an anticipated prolonged time for recovery, CMS understands that these surgeries require a high level of care.

Terry discusses some of these procedures in this episode of the CodeCast podcast and why it is important not only to your practice revenue but your patient’s financial choices.

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So many providers have been looking into setting up either an OBL (Office-Based Lab) or an ASC (Ambulatory Surgery Center) with their partners.

Terry discusses the topic in general terms before you dive in to determine if this could be a way for your providers to get back to a profitable practice. After the year we have had this could offer convenience to the patient to get those elective surgeries and procedures done now.

If you haven’t considered this before, listen to this podcast and the reimbursement impact and you may start considering the possibility now.

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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/

Virtual Check-ins have been confusing: not only on when to use them, but CMS added more to the list in 2021!

The confusion continues for physicians, NPs, PAs and therapy ancillary staff on when to use these HCPCS G-codes, or what Terry refers to as, “G-we are watching you!”

The episode of the CodeCast should clear up any confusion on usage, and help to make sure you are capturing these services appropriately.

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You can subscribe to our podcasts via:

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* Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights

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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/