CodeCast | Medical Billing and Coding Insights Terry Fletcher
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National Speaker and Healthcare Consultant, Auditor and Educator, Terry Fletcher CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, knows from over 25 years medical reimbursement industry experience that Coding, Billing and Compliance for physician practices and hospitals can be tough to navigate. Her CodeCast Podcast series will share insights to current rules and regulations the Medicare payer requires, along with Commercial insurance plans' rules and reimbursement challenges. Discover revenue opportunities to maximize reimbursement in your medical practice, focusing on different medical specialties and platforms each episode.
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Compliance Issues With MD/QHP Collaboration Agreements
You must have a collaboration agreement in place when hiring mid-level providers or QHPs (such as nurse practitioners, physician assistants, or clinical nurse specialists) to act on your behalf with treating patients.
Collaboration agreements are mandatory in most states but rules differ from state to state. Also, due to failed compliance policies, lack of understanding of state laws, and providers forgetting to report when this relationship ends, the physician may still listed as their supervising physician.
Terry uncovers these issues that cost physicians not only money, but possibly their license to practice.
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
* Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
* iHeart Radio – https://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/
If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/ -
Critical Care Inclusions and Carve-Outs
Critical care in 2024 can be tricky, with inclusions, carve-outs, and a time component.
Are there exceptions when PA/NPs are involved in critical care services? What has to be documented? You may find some rules you didn’t know about.
Terry has all of the answers in this episode of the CodeCast podcast, sponsored by Decision Health, LLC.
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
* Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
* iHeart Radio – https://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/
If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/ -
Can you bill an E/M service when the patient isn’t present?
What happens when a provider meets with a family to discuss and develop a care plan for patients? Providers will give the parent the option to have the patient present or just the parent/guardian due to the sensitivity of the discussion.
Some scenarios where this may occur are cancer patients where the family wants to talk to the provider alone on treatment options or mortality issues, or pediatric patients where the conversation may be too sensitive to have the child present. But what can you bill for?
Terry covers this controversial topic in this edition of the CodeCast podcast.
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
* Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
* iHeart Radio – https://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/
If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/ -
2-Midnight Rule and MA plans
When a Medicare beneficiary arrives at a hospital in need of medical or surgical care, the physician or other qualified practitioner must decide whether to admit the beneficiary as an inpatient or treat him or her as an outpatient.
These decisions have significant implications for hospital payment and beneficiary cost sharing. Not all care provided in a hospital setting is appropriate for inpatient, Part A payment.
Terry discusses the 2-midnight rule, and how that impacts both Part A and Part B providers and patients. There is more to consider than meets the eye.
Terry also covers what CMS recently published in the Final Rule for MA plans.
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
* Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
* iHeart Radio – https://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/
If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/ -
Did you know this is a HIPAA violation?
In this week’s episode of the CodeCast podcast Terry discusses collecting information on medical practice websites.
How you collect data on a website is equally as important as the data itself. If a patient doesn’t mention a medical condition, their information may still be considered as PHI.
Terry covers requirements, such as PHE and ePHI access, securing data in an encrypted manner or HIPAA-compliant location, and having a system in place to destroy sensitive data that is no longer needed.
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
* Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
* iHeart Radio – https://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/
If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/ -
E/M Services: Stable or Unstable Chronic Conditions?
Terry discusses how to be accurate in your documentation when picking the low, moderate or high element(s) of MDM.
When listing “problems addressed” in your E/M record, and considering chronic conditions, the definition of a stable, chronic illness, per AMA/CPT states, “stable” to categorize MDM as defined by the specific treatment goals for an individual patient.
A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function. By this definition, a patient might be living with a chronic condition that is controlled.
However, if they are falling short of their treatment goals, they would not be considered “stable.”
This shows that the spirit of the new AMA/CPT E/M Documentation rules are about patient-centered care and that every patient has a unique set of goals and circumstances: achieving these personalized objectives truly determines “stability.”
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
* Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
* iHeart Radio – https://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/
If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/
Customer Reviews
Great podcast!
Terry does a great job breaking things down to be easily understandable in the often hard to understand coding and billing world.
Stop talking politics that's not what we're here for
The information about medical coding and billing appears accurate, but delivered as it is with petty and poorly informed political ramblings makes one wonder how trustworthy and knowledgeable the podcaster really is.
Great podcast!
Very helpful information for the medical coder. Terry does a great job explaining things.