CodeCast | Medical Billing and Coding Insights

Compliance: it’s a “dirty word” in Healthcare that haunts practice managers day-in and day-out as they try to avoid denials, audits, and recoupments.

Achieving compliance is no small task given the complexity of payer requirements and ever-changing regulations. Employee burnout also makes it difficult to maintain compliance because when staff is burned out, as they’re less likely to perform at their best.

Maintaining compliance requires ongoing attention and an ‘all hands on deck’ attitude. It also requires a written plan that details exactly how staff will promote accuracy and ethical practices.

Terry gives you some insights on how, and why, to add a compliance plan into your practice management strategy.

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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/

Terry’s Top Ten Tuesday focus this month is on breaking healthcare news. From PHE being extended at the last minute, to CMS audits starting in a week, and HHS plans for payment parity across the OPPS to the physician reimbursement platform, not one stone is left unturned in the latest CodeCast.

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You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627

* Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga

* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX

* Stitcher – http://www.stitcher.com/s?fid=156874

* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/

* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg

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

Now that most states are experiencing a surge of COVID-19 cases, many states are also on the verge of a second lockdown as well.

Terry Fletcher helps guide you in getting back to basics in the latest episode of the CodeCast podcast.

It is time to take inventory of some of the ways our practices have become lax in our business operations, our provider documentation efforts, and how we correspond with outpatients.

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You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627

* Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga

* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX

* Stitcher – http://www.stitcher.com/s?fid=156874

* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/

* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg

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

Medical Decision Making specifically refers to the complexity of establishing a diagnosis and/or selecting a management option. Medical necessity refers to the appropriateness of the service provided for a certain condition.

Problems can arise with training and documentation, when MDM and medical necessity are used interchangeably, or when practices and payers define medical necessity differently.

Terry will help you understand the differences and also prepare you for what’s ahead in 2021 in today’s podcast episode.

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You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627

* Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga

* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX

* Stitcher – http://www.stitcher.com/s?fid=156874

* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/

* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg

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

Medicare has adopted a new prior authorization program effective July 1st. Also, as of June 17th, the Medicare Administrative Contractors (MACs) were required to start accepting requests.

It is important to note that this is a nationwide program, however, it relies on the local decisions of the MACs. If you put their medical necessity standards next to each other, there are significant differences.

Terry discusses the things you need to know about the program: the procedures that are affected, Part A and Part B Reimbursement implications, and more.

Terry will also talk about capturing revenue in the event of a no-show.

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You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627

* Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga

* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX

* Stitcher – http://www.stitcher.com/s?fid=156874

* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/

* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg

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

In the past 12 months, there were 393 protected health information breach incidents reported to HHS. The incidences included malicious email hacking, unauthorized access to EHRs, and medical records as well as inadequate third-party business agreements.

It is our job as healthcare professionals to protect patient health information.

Here is a list of common reasons for HIPAA violations, so you are aware of what is being reported… and how to be proactive in protecting our patient’s information.

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You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627

* Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga

* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX

* Stitcher – http://www.stitcher.com/s?fid=156874

* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/

* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg

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

Whether you are a novice or a seasoned negotiator, payer contracts can be complicated and difficult to interpret: even with an attorney or a consultant by your side.

Terry Fletcher shares her experience walking physicians and medical practices through this process – something she has done many times over the past 25 years.

There are always negotiating points to keep in mind during “debates” with payers over contract language, inclusions, exclusions, and coverages.

On this episode, Terry goes through her top steps in the contract negotiation process to ensure your reimbursement security in the foreseeable future.

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You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627

* Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga

* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX

* Stitcher – http://www.stitcher.com/s?fid=156874

* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/

* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg

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

On the latest CodeCast, Terry discusses physician and medical provider addendums, late entries and corrections.

CMS and their MAC carriers have referred to this practice as legitimate and are aware it does happen: that is why the Medicare Program Integrity Manual, Chapter 3 addresses the topic.

When a deficiency is discovered in a provider’s notes, it is common practice to create a late entry or an addendum or make a minor correction to the medical record. It is important to know how to correctly make the changes, but first, it is important to know the difference between a late entry an addendum or correction, as they are handled differently.

You need to know how to apply these corrections accurately to ensure only clinical documentation integrity and the corrections to the medical record, before the claim’s submission and/or medical review will be considered in determining the validity of the services billed.

Subscribe and Listen

You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627

* Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga

* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX

* Stitcher – http://www.stitcher.com/s?fid=156874

* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/

* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg

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

There are three main sources of funding for mitigating the impact of the COVID-19 pandemic on your healthcare business.

Before you being, however, there’s fine print that needs to be read to make sure you can get these sources of money as grants, and not loans.

You also have to be careful not to double-dip.

Some of these programs were short-lived, while some still have more funding coming. Terry will assist in your navigation of these waters with recommendations to make sure you can pass the HHS audit that is coming.

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You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627

* Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga

* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX

* Stitcher – http://www.stitcher.com/s?fid=156874

* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/

* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg

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

Brace yourself: medical audits are coming.

With the currently relaxed rules, it is inevitable. The lack of oversight on HHS monies given to practices, and the liberties many are taking with the pandemic, allowing for everyone, it seems, to bill for medical services, something has to give.

Have you taken a good look at your claims lately? Are you in control of your compliance? Do you spot check your coders and billers on what is submitted to your payers to avoid an audit?

It’s time to think about this and what to do to avoid a formal audit. Tune in this week for a list of best practices to help avoid a payer audit.

Subscribe and Listen

You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627

* Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga

* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX

* Stitcher – http://www.stitcher.com/s?fid=156874

* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/

* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg

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