CodeCast | Medical Billing and Coding Insights

Telehealth isn’t going anywhere, but many practices still don’t have a solid audit plan in place. With Medicare’s proposed rules now finalized for 2026—and the added uncertainty of another potential government shutdown—it’s easy to see why compliance teams are feeling the pressure. In this episode, Terry breaks down five practical tips to help you strengthen or update your telehealth audit plan, especially if you’re providing office visits via telehealth through January 30, 2026. We also highlight insights from Sonal Patel and her excellent NAMAS article on this very topic. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Telehealth Compliance Tips for 2026 appeared first on Terry Fletcher Consulting, Inc..

Terry kicks off 2026 by clearing up a major misunderstanding in the provider and manufacturer community. Some believed that CMS’s last‑minute withdrawal of the LCD for skin substitute products would delay or stop the 2026 reimbursement changes. That’s not the case. The LCD withdrawal has no impact on the Final Rule, and the new 2026 reimbursement methodology for skin substitutes will move forward exactly as finalized, using an incident‑to payment structure. In this episode, Terry breaks down the difference between the policy halt and the reimbursement rules, and explains what providers need to know about the updated approach to skin substitutes and skin graft products and services. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Skin Substitutes and Grafts LCD vs Reimbursement 2026 appeared first on Terry Fletcher Consulting, Inc..

Terry closes out the year with a deep dive into Medicare’s newly permanent “Virtual Supervision” rule taking effect in 2026, along with a refresher on the current requirements for reporting services under a physician’s NPI versus an NPP’s NPI. She urges listeners to approach this shift carefully, outlining the risks tied to non‑compliance, malpractice exposure, and whether patient‑safety concerns outweigh any potential financial upside. Tune in to get the context you need before jumping into this virtual model. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Is Virtual Supervision a Good Idea for 2026? appeared first on Terry Fletcher Consulting, Inc..

2026 is coming in fast, and with it comes a fresh wave of CPT code changes that every healthcare professional needs to be ready for. On today’s episode of the CodeCast podcast, we break down the newest updates impacting Cardiology, Peripheral Vascular services, and several other key specialties. From what’s changing to why it matters, we’ll walk through the revisions, additions, and potential pitfalls so you can stay compliant and ahead of the curve as the new year approaches. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post 2026 CPT Code Changes Are Coming Fast appeared first on Terry Fletcher Consulting, Inc..

Auditing split/shared encounters can become confusing when providers, auditors, and coders are not aligned. CPT and CMS have both issued guidance to help clarify how these services should be billed. In this episode of the CodeCast podcast, Terry breaks down where to begin when auditing and educating on Split/Shared visits, what payers are currently saying, and how to maintain compliance for physicians and NPPs to prevent payer audits or confidently address them when they occur. She also gives a shout out to Sonda Kunzi, CPC, for her NAMAS article referenced during the discussion. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Audit Tips For Split/Shared Visits appeared first on Terry Fletcher Consulting, Inc..

When auditing risk of management in an E/M note, how are over-the-counter (OTC) medications scored? Under the 1995/1997 guidelines, they were categorized in the “low” risk row. However, the 2021 guidelines provide no examples under minimal or low risk, relying instead on AMA and Medicare guidance. Terry explains this distinction and highlights the difference between an acute uncomplicated illness and an acute illness with systemic symptoms. Take a listen. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post “Risk” E/M Element OTC Medications appeared first on Terry Fletcher Consulting, Inc..

Medical record signatures are more than the macro “electronically signed by Dr. Jack Jones.” A provider’s signature is a legal attestation that the physician or provider performed, reviewed, and/or agreed with the documentation. Is this actually true, or are your EMR auto-signatures taking over? Terry discusses this critical aspect of medical record documentation compliance, with a shout-out to NAMAS for an article that also addresses the topic. Plus, a bonus update on the G0136 add-on code for 2026. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post MR Signature Compliance appeared first on Terry Fletcher Consulting, Inc..

Across the country, commercial payers are quietly down-coding E/M services without issuing ADRs and without providing notice. Office visit reimbursements are being arbitrarily reduced based on payer algorithms rather than a proper review of documentation for compliance. In today’s CodeCast episode, Terry sheds light on this growing problem and explains how to take proactive steps […] The post Watch for Payer Automatic Down-Coding Without Notice appeared first on Terry Fletcher Consulting, Inc..

When auditing a medical record, a common mistake is viewing it solely from a coding perspective rather than an auditing perspective. True auditing requires examining not just the encounter itself, but also what occurred before, after, and around it. Focusing only on coding can result in missed compliance elements and insufficient support for what was—or […] The post Auditing a record isn’t the same as coding it appeared first on Terry Fletcher Consulting, Inc..

The September 2025 issue of CPT® Assistant raised important questions about how to appropriately level an evaluation and management (E/M) encounter when the presenting problem is an acute, uncomplicated illness or injury. A growing number of providers have been assigning Level 4 codes simply because an antibiotic was prescribed. However, this approach may not be […] The post Leveling a Visit for an Acute Uncomplicated Illness appeared first on Terry Fletcher Consulting, Inc..

Medical billing and coding encompasses a wide range of responsibilities—from patient registration and claim reimbursement to final payment delivery to the provider. Navigating this process requires close collaboration among billers, coders, insurance companies, patients, and various healthcare professionals. Although often grouped together as a single discipline, billing and coding are distinct roles that work in […] The post Claim Denials: Coding Mistake or Billing Oversight? appeared first on Terry Fletcher Consulting, Inc..

As more practices begin offering screening services, questions around billing for Medicare-specific G codes are becoming more common. In this episode, Terry breaks down when it’s appropriate to bill for preventive services, which providers are eligible, and what requirements must be met. To bill G codes, providers must be enrolled as Medicare suppliers and follow […] The post Understanding Who Can Bill Preventive G Codes appeared first on Terry Fletcher Consulting, Inc..

CMS has updated its stance on Medicare payments during the federal shutdown, confirming that only certain claims will be held—reversing earlier guidance that hinted at a wider pause. But what does this mean for Telehealth and other temporary policies that expired on October 1? Terry breaks down the latest developments, what’s at risk, and what […] The post What the Shutdown Means for Medicare and Telehealth appeared first on Terry Fletcher Consulting, Inc..

In this episode, Terry tackles a common pitfall in coding and CDI workflows: skipping straight to the Assessment and Plan (A/P) section of an E/M note to determine service level. Are you overlooking key documentation that could support medical decision-making, risk, or time? She also calls out a frequent habit among surgery coders—coding from the […] The post Tips on Reviewing MRs for Coding Accuracy appeared first on Terry Fletcher Consulting, Inc..

Terry explores the critical role coders and auditors play in holding providers accountable. From reviewing clinical documentation and medical record notes to verifying patient eligibility, addressing cases where minors receive treatment without a parent present, and identifying excessive repeat visits lacking medical necessity, this episode highlights the detailed oversight that ensures provider compliance and quality […] The post Coders and Auditors Hold Providers Accountable appeared first on Terry Fletcher Consulting, Inc..

In this episode, Terry breaks down the upcoming Prior Authorization pilot programs launching for Medicare Part B Professional Services on January 1, 2026, and for Ambulatory Surgical Centers starting December 15, 2025. She outlines which medical services will be impacted and what providers need to know as these changes roll out. Terry also shares the […] The post Medicare’s Prior Auth Pilot: What It Means for You appeared first on Terry Fletcher Consulting, Inc..

In this episode of the CodeCast Podcast, Terry addresses a common misconception among medical providers: the belief that simply listing a patient’s medications or repeatedly noting “continue meds” is enough to support a moderate-level evaluation and management visit, such as CPT codes 99214 or 99204. In reality, this documentation alone does not meet the criteria.= […] The post Are you documenting prescription drug management risk? (Fixed Audio) appeared first on Terry Fletcher Consulting, Inc..

A split or shared visit is an evaluation and management (E/M) service performed jointly by a physician and a non-physician practitioner (NPP) from the same group in a facility setting. Under applicable laws and regulations, either the physician or the NPP may bill for the service—provided they deliver it independently. Reimbursement goes to the practitioner […] The post Split/Shared Visits Update appeared first on Terry Fletcher Consulting, Inc..

In this week’s episode of the CodeCast Podcast, Terry Fletcher previews potential Telehealth updates and changes set to take effect on October 1. She also discusses how major surgery can be considered a risk factor in Evaluation and Management coding, and explains the importance of properly sequencing ICD-10-CM codes to ensure reimbursement success. Listeners are […] The post Telehealth October 2025 Preview appeared first on Terry Fletcher Consulting, Inc..

In this episode of CodeCast, Terry takes a closer look at the growing issue of undercoding in healthcare. Often misunderstood or overlooked, undercoding involves reporting fewer services than were actually provided, assigning a lower-level code than warranted, or inaccurately documenting patient encounters. While some may view it as a conservative approach to avoid audits or […] The post Undercoding Is Real—And It’s Costing You appeared first on Terry Fletcher Consulting, Inc..