In today’s episode of the CodeCast podcast, Terry untangles the complexities of Protected Health Information (PHI) and HIPAA as they relate to workers’ compensation cases. She’ll clarify the rights of both patients and employers when requests for PHI reach a healthcare provider’s office. This can be a tricky area, especially given potential state-specific regulations. This […]

The post HIPAA and Workers Comp Patients appeared first on Terry Fletcher Consulting, Inc..

A question I’m often asked is, “Why do physicians charge so much?” There’s no easy answer, as there isn’t a fixed price list for medical services. Due to the healthcare system’s complexity and the absence of set prices, providers are largely free to charge what the market will bear. However, can there be consequences for […]

The post Can physicians charge whatever they want to Insurance Payers? appeared first on Terry Fletcher Consulting, Inc..

Engaging with “bad actors” in medical billing can have serious consequences for both patients and healthcare providers. More and more providers are engaging without checking. Here’s what could happen. Terry discusses it all with examples. Legal repercussions: Providers can face hefty fines, civil or criminal charges, and even loss of their medical license for engaging […]

The post Watch out for “bad actors” on billing advice appeared first on Terry Fletcher Consulting, Inc..

In this episode, Terry challenges all medical professionals. What is your role in managing the patient experience? A lack of patient prep can lead to an incomplete encounter for the physician including excessive visits. It can also lead to leakage in all departments, including the RCM staff’s ability to perform their job. Terry offers her […]

The post Is the provider “prepared” to see the patient? appeared first on Terry Fletcher Consulting, Inc..

Since the implementation of the No Surprises Act (NSA) in January 2022, out-of-network (OON) reimbursement has become a complex and resource-heavy challenge for hospital and health system revenue cycle leaders. Although designed to shield patients from unexpected medical bills, the legislation has placed continuous financial pressure on physician practices and hospital systems. It has led […]

The post No Surprises Act and OON Claims appeared first on Terry Fletcher Consulting, Inc..

Medical necessity is defined as services that are reasonable and necessary for diagnosis or treatment of an illness or injury, or to improve the functioning of a malformed body member and are not excluded under another provision of the Medicare Program. Unfortunately, we have many practices trying to slide under the radar the experimental and/or […]

The post Medicare Rules For Experimental or Investigational Services appeared first on Terry Fletcher Consulting, Inc..

Terry discusses Behavioral Health services, best practices documentation and coding specifics. Also, Terry offers some bonus discussion on RAC auditors trying to bait providers into not responding to ADR requests. Check out this episode for intel on these important topics and more. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – […]

The post Behavioral Health Coding and Documentation appeared first on Terry Fletcher Consulting, Inc..

With all of the AI implementation into EHR and EMR systems, there is concern about how providers rely on these AI shortcuts more than ever. Without proper safeguards, accountability, and compliance perimeters, relying on AI could be problematic. Terry discusses the red flags to look for and how to proceed with caution in this new […]

The post Did you know AI is integrated into EMRs? appeared first on Terry Fletcher Consulting, Inc..