CMS published their PFS on July 10th. You have 90 days to comment and be heard on these changes including the proposed 2.93% reduction to the Physician Fee schedule. In this edition of the CodeCast, Terry goes over the talking points and what Part B providers can expect coming into the new 2025 calendar year. […]

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Terry discusses when it is and isn’t appropriate to report a preventative visit with an office visit on the same date. How did the patient present? What is the share of the cost-to-patient implications? And what will payers want to see for medical necessity? Terry covers it all in this edition of CodeCast podcast. Subscribe […]

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In today’s episode of the CodeCast podcast, Terry updates you on the latest CMS NCCI Edits, effective July 1st. She gives you the insight on the PTP and MUEs expected, along with some commentary and best practices on charging patients for no-show appointments. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts […]

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Principal Care Management (PCM) services are services for a single high-risk disease, 30 minutes a month, personally provided by a physician or NPP. This is for patients with one complex chronic condition expected to last three months which places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death. Does your patient […]

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Can you guess the main reason why medical billing claims are rejected? According to recent studies, most clinics account for 15-25% of inaccurately submitted monthly claims. Those inaccuracies must be corrected, resulting in an annual loss of revenue worth tens of thousands of dollars. Among the most popular reasons medical claims return to a clinic […]

The post Top 10 Coding and Billing Mistakes – Let’s Fix It! appeared first on Terry Fletcher Consulting, Inc..

You must make sure your providers and coders understand the overarching LCD criteria for reporting TPIs (Trigger Point Injections). As of April 1st, five MACs have tightened their rules for TPI coding and reporting. There are new frequencies, ICD-10-CM, anatomical territories, and MUE rules for these services. Terry outlines the rules and reminds practices that […]

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How do you know if your role is classified as a Coder or a Biller? Coders typically work in the back end of the facility, focused on interpreting medical records and assigning appropriate codes. Billers interact directly with patients, collecting payments and entering patient information into the appropriate systems. However, there is also a crossover […]

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All CPT codes have an expected range of complexity and uses, but when a particular procedure or surgery performed has exceeded the normal range of complexity, modifier -22 can come into play. Modifier -22 is defined as increased procedural services and demonstrates when a physician has gone above and beyond the typical framework of a […]

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