Taking the Business of Medicine to the next level
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Today on the CodeCast Podcast, Terry discusses a topic that comes up in auditing conversations frequently: “that an auditor needs to specialize in a certain specialty before they can audit E/M services for that specialty.” That is not necessarily true. I understand where that thought comes from. It can absolutely help for an auditor to be familiar with the anatomy, medications, terminology, and…
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…
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,…
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…
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…
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…
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…
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…
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…
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…
