CodeCast | Medical Billing and Coding Insights

Terry Fletcher

Taking the Business of Medicine to the next level

  1. HACE 2 DÍAS

    Notice of Privacy Practices 2026

    HHS recently released updated Notices of Privacy Practices (NPPs), introducing changes that go far beyond standard template revisions. The update includes new requirements for health care providers, health plans, and Part 2 patient notices related to sensitive protected health information. While many in health care associate “NPP” with Non-Physician Practitioner, in this case it refers to patient privacy notice requirements involving highly sensitive health information, including substance use disorders (SUD), reproductive health information, and mental health records. These updated privacy notice requirements became effective February 16, 2026, and covered entities must comply by July 1, 2026. In this episode, Terry breaks down what has changed, what practices need to update immediately, and how to ensure your organization remains compliant with both HIPAA and the new federal privacy requirements surrounding sensitive PHI. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Notice of Privacy Practices 2026 appeared first on Terry Fletcher Consulting, Inc..

    12 min

  2. 12 MAY

    Telehealth Modifiers 95 and 93 Compliance

    Watch the claims data behind telehealth modifier 95 and audio-only modifier 93 as denial trends for high-volume CPT codes and place of service combinations raise major compliance concerns. Terry breaks down the most common causes of denials, including incorrect POS reporting, documentation gaps, and billing practices that could trigger audit scrutiny. She also explains why relying on coding forums for definitive coding advice can create serious compliance risks for providers and practices. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Telehealth Modifiers 95 and 93 Compliance appeared first on Terry Fletcher Consulting, Inc..

    18 min

  3. 5 MAY

    Incident to Physician Participation Rules

    While Centers for Medicare & Medicaid Services does not explicitly define a strict “12-month rule,” its guidance does require that the physician’s involvement reflect ongoing, active participation in the patient’s course of treatment. That said, legal and compliance experts consistently caution that if a physician has not personally seen a patient within 12–24 months, billing subsequent non-physician practitioner (NPP) visits as “incident to” may present elevated audit risk. Terry breaks down the lack of clear regulatory thresholds and outlines practical steps to help protect your practice if an audit inquiry occurs. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Incident to Physician Participation Rules appeared first on Terry Fletcher Consulting, Inc..

    16 min

  4. 28 ABR

    CCM and CoCM Compliance Risks on Social Media

    Terry breaks down a recent social media post that exposed a practice’s compliance issues with time based care management services, drawing exactly the kind of attention no organization wants. Although the original post was quickly deleted after backlash, the situation highlights a bigger issue. In this episode, Terry emphasizes the importance of using sound judgment online and ensuring time based services are properly documented and driven by medical necessity, not simply billed because they can be. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post CCM and CoCM Compliance Risks on Social Media appeared first on Terry Fletcher Consulting, Inc..

    11 min

  5. 21 ABR

    Modifier 59 Audits Denials and Post-Op Pain Injections

    Modifier 59 (Distinct Procedural Service) continues to face intense scrutiny in 2026 due to widespread misuse, triggering audits, denials, appeals, and payer recoupments tied to medical necessity concerns. With enforcement on the rise, it’s more important than ever for coders to understand when—and when not—to apply this modifier correctly. On today’s episode of the CodeCast Podcast, Terry Fletcher breaks down proper Modifier 59 usage, common pitfalls leading to audits, and key documentation requirements to support compliant coding. She also covers post-operative pain injections, including when they can be reported and which providers are eligible to bill for them. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Modifier 59 Audits Denials and Post-Op Pain Injections appeared first on Terry Fletcher Consulting, Inc..

    14 min

  6. 14 ABR

    Fracture Coding Accuracy

    Coding fracture care using CPT and ICD-10-CM can be challenging—especially when documentation from providers lacks key details. In this episode of the CodeCast Podcast, Terry breaks down exactly what coders should look for in physician notes, including essential documentation elements and common gaps. She also shares expert insights and practical tips to help ensure accurate coding, proper reporting, and compliance when working with fracture treatment cases. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links   The post Fracture Coding Accuracy appeared first on Terry Fletcher Consulting, Inc..

    16 min

  7. 7 ABR

    Undercoding Is Now a Compliance Risk Providers Can’t Ignore

    In medical coding and compliance, attention is often focused on overcoding due to its association with fraud, waste, and abuse. However, undercoding is an equally important—and frequently misunderstood—issue. While it may seem like a safer way to avoid scrutiny, undercoding is still a coding error, a compliance concern, and a reportable variance under both CMS and OIG guidelines. Recent TPE audits are increasingly targeting undercoding, as it signals a failure to accurately report services and can negatively impact compliance, data integrity, and reimbursement. In this episode, Terry breaks down why undercoding is now on the radar and why providers need to address it immediately. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Undercoding Is Now a Compliance Risk Providers Can’t Ignore appeared first on Terry Fletcher Consulting, Inc..

    13 min

  8. 31 MAR

    Top 10 Tuesday Medical Coding Q and A

    In this episode of the CodeCast Podcast, Terry Fletcher answers key medical coding and billing questions in a detailed Q&A session designed for coders, billers, auditors, and healthcare providers. This episode covers E/M coding with minor procedures and when services can be billed separately, RTM (Remote Therapeutic Monitoring) for CPAP patients, CO-96 Medicare denials including what they mean and how to properly appeal, along with real-world coding scenarios and expert guidance to help improve reimbursement and reduce claim denials. If you’re looking to stay compliant, optimize your coding practices, and better understand payer requirements, this episode delivers practical, actionable insights you can use immediately. Be sure to subscribe to the CodeCast Podcast for weekly updates on medical coding, billing, and compliance. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Top 10 Tuesday Medical Coding Q and A appeared first on Terry Fletcher Consulting, Inc..

    23 min
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Taking the Business of Medicine to the next level

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