CodeCast | Medical Billing and Coding Insights

Эпизоды

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  CMS Fee Schedule Proposals 11.08.2026 13мин

  What are we anticipating for 2027 in the MPFS? This week Terry gives us a rundown on what to expect, how to respond before the comment period ends, and what needs to happen to strengthen our private practice providers. Listen in… Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post CMS Fee Schedule Proposals appeared first on Terry Fletcher Consulting, Inc..
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  Incident to Update: Commercial Plans 04.08.2026 9мин

  Incident-to Billing Update: More Blue Cross Blue Shield plans, along with the three largest commercial insurance carriers, are tightening their policies on the reporting and reimbursement of services billed under Medicare’s “incident-to” guidelines. In today’s episode of the CodeCast Podcast, Terry reviews these recent policy changes, highlights key effective dates, and explains what physicians, coders, billers, and practice managers need to know before submitting claims. Tune in to learn how these evolving payer requirements could impact your reimbursement and the compliance steps you should be taking now. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Incident to Update: Commercial Plans appeared first on Terry Fletcher Consulting, Inc..
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  AI ChatBots Are Not Physicians 28.07.2026 12мин

  With more patients turning to large-language models such as ChatGPT, Gemini, Claude and others to answer their questions about symptoms, medical conditions and more, the American Medical Association (AMA) is offering some go-to advice that will help patients get more out of their experience with AI chatbots while staying safe. The key to effectively using AI chatbots, is to understand they are not a replacement for a physician. Terry discusses the AMA 5 steps to AI ChatBot safety and what physician practices need to do to protect patients in this uncertain and sometimes, unchecked reality. AI chatbots are not as a substitute for the evidence-based, personalized guidance of an actual doctor. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post AI ChatBots Are Not Physicians appeared first on Terry Fletcher Consulting, Inc..
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  Can ancillary staff be part of shared services under E/M? 21.07.2026 14мин

  In today’s episode of the CodeCast podcast, we’re breaking down why E/M time belongs to the physician or qualified healthcare professional performing the service, why time from other team members cannot be combined to support the E/M level (in the office setting), and an important Medicare reminder: shared visits do not apply in the office or other outpatient setting. Let’s dive into the rules so you can code with confidence and avoid a common compliance pitfall. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Can ancillary staff be part of shared services under E/M? appeared first on Terry Fletcher Consulting, Inc..
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  Telehealth: Where the Patient is or Where the Provider is? 14.07.2026 14мин

  Terry tackles a growing compliance issue in telehealth: where the patient is located at the time of the visit. While physicians generally must be licensed or otherwise authorized to practice in the state where the patient is physically located, evolving payer policies and Medicare rules have added new layers of complexity. From commercial insurance requirements to CMS guidance on services provided outside the United States, Terry explains what providers need to know to remain compliant and avoid costly reimbursement pitfalls. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Telehealth: Where the Patient is or Where the Provider is? appeared first on Terry Fletcher Consulting, Inc..
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  How Safe Is AI in Healthcare? 07.07.2026 17мин

  Artificial intelligence is advancing faster than the laws designed to regulate it. While individual states continue to enact legislation governing the development and use of AI, the federal government is simultaneously working toward a nationwide regulatory framework that could preempt many state laws. In this episode of the CodeCast Podcast, Terry examines the evolving legal landscape surrounding AI, the current lack of mandated safeguards, and the ongoing tension between state and federal oversight. She also discusses the compliance and operational risks healthcare organizations should be considering now, along with practical best practices to help mitigate those risks as AI becomes increasingly integrated into healthcare. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post How Safe Is AI in Healthcare? appeared first on Terry Fletcher Consulting, Inc..
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  CMS-1500 Form Compliance 30.06.2026 13мин

  Every CMS-1500 claim includes a set of certifications, attestations, and legal statements printed on the reverse side of the form. While these statements may seem like standard administrative language that has been around for decades, they carry significant legal and compliance implications. In this episode, Terry breaks down what these certifications actually mean and why every claim submitted is a legal representation that the services billed were properly documented, medically necessary, accurately coded, and provided in compliance with applicable regulations. She also explains why understanding these attestations is essential to maintaining a strong revenue cycle management (RCM) workflow, reducing compliance risk, and helping organizations avoid costly payer audits. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post CMS-1500 Form Compliance appeared first on Terry Fletcher Consulting, Inc..
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  Preparing for the 2027 ICD-10-CM Updates 23.06.2026 21мин

  Released on June 5, 2026, the ICD-10-CM update includes 190 new codes, 30 deleted codes, and four revised codes. While these changes take effect on October 1, 2026, they are considered part of the FY 2027 ICD-10-CM update because the code set follows the federal fiscal year publication cycle. In today’s episode, Terry breaks down some of the most notable additions and revisions, explains what healthcare professionals need to know before implementation, and shares practical insights on how these updates may impact coding and documentation. As a bonus, Terry also addresses a telehealth question that continues to generate confusion and discussion across the industry. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Preparing for the 2027 ICD-10-CM Updates appeared first on Terry Fletcher Consulting, Inc..
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  E/M Documentation Is Not a Checklist: Tell the Patient’s Story 16.06.2026 20мин

  A growing concern among auditors, coders, and compliance professionals is the increasing reliance on template driven documentation. While electronic health records have improved efficiency, copied, carried-forward, and pre-populated information can create significant compliance risks when it does not accurately reflect the patient’s current encounter. Auditors frequently identify contradictory statements, outdated histories, normal findings that conflict with the assessment and plan, and documentation that appears disconnected from the services actually provided. Simply completing documentation fields does not create credible documentation. On this episode of the CodeCast Podcast, Terry discusses why E/M documentation is not a checklist, the compliance risks associated with template generated notes, and practical strategies to ensure your documentation accurately tells the patient’s story and supports the care delivered. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post E/M Documentation Is Not a Checklist: Tell the Patient’s Story appeared first on Terry Fletcher Consulting, Inc..
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  Credentials Alone Are Not a Career Path in Healthcare 09.06.2026 19мин

  At some point, we have to stop and ask ourselves: What are we truly building for our future? Where is our career in healthcare going? I have all of these credentials in coding, billing, compliance, practice management, and prior authorization, but what does that really say about me? I want to be clear that I believe credentials matter. I know the work, time, money, and dedication it takes to earn them. However, we also need to be honest with ourselves about something that is becoming increasingly obvious in healthcare: collecting credentials alone is not a career plan. AI is changing healthcare, and we need to start looking at the bigger picture. Terry discusses what that means in today’s episode of the CodeCast podcast and asks the questions that may be uncomfortable to consider. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Credentials Alone Are Not a Career Path in Healthcare appeared first on Terry Fletcher Consulting, Inc..
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  Note Bloat Is an Auditor’s Nightmare 01.06.2026 11мин

  Auditors, coders, billers, and even physicians often find themselves searching through pages of documentation trying to answer one basic question: what was actually evaluated, managed, and medically necessary during a single patient visit? With note bloat from copied and pasted EMR documentation and pulled-forward notes, it has become increasingly difficult to determine what actually happened “today.” In this episode of the CodeCast Podcast, Terry breaks down this compliance challenge and explains how providers can better manage documentation to ensure accuracy, clarity, and compliance. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Note Bloat Is an Auditor’s Nightmare appeared first on Terry Fletcher Consulting, Inc..
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  Can Physicians and Clinicians Use Texting for Patient Care? 26.05.2026 12мин

  Text messaging for communicating orders is not prohibited by CMS or The Joint Commission, but there are important HIPAA privacy and security considerations that healthcare organizations must understand before using this method of communication. According to guidance from the AMA, providers must evaluate compliance requirements and safeguards when using text messages in patient care workflows. In this episode, Terry explains the details of using text messaging for orders, what organizations need to know to remain compliant, and practical considerations for implementation. Plus, hear about a newly accepted AMA CPT Committee decision for 2027 that could impact future coding and reporting. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Can Physicians and Clinicians Use Texting for Patient Care? appeared first on Terry Fletcher Consulting, Inc..
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  Notice of Privacy Practices 2026 19.05.2026 11мин

  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..
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  Telehealth Modifiers 95 and 93 Compliance 12.05.2026 18мин

  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..
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  Incident to Physician Participation Rules 05.05.2026 16мин

  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..
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  CCM and CoCM Compliance Risks on Social Media 28.04.2026 11мин

  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..
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  Modifier 59 Audits Denials and Post-Op Pain Injections 21.04.2026 14мин

  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..
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  Fracture Coding Accuracy 14.04.2026 15мин

  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..
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  Undercoding Is Now a Compliance Risk Providers Can’t Ignore 07.04.2026 12мин

  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..
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  Top 10 Tuesday Medical Coding Q and A 31.03.2026 23мин

  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..