Summary

In this episode, Terry Fletcher and Sean Weiss discuss the latest Medicare final rule, its implications for healthcare providers, and how stakeholders can engage in the comment process to influence policy changes. They explore key topics like telehealth flexibilities, modifiers, and upcoming payment adjustments for 2027.

Key Topics

• Medicare final rule published on July 14th
• Comment period ending September 14th, 2023
• Telehealth flexibilities extended until 2028
• Modifiers BB and BC for incident two services
• Proposed payment reductions for multiple procedures
• Importance of stakeholder comments in policy shaping
• Impact of Medicare policies on commercial payers
• G2211 complexity add-on code changes
• Future implications for physician billing and RVUs

• Stakeholders must comment by September 14 to influence policy.
• Telehealth flexibilities are extended until the end of 2027.
• Modifiers BB and BC will identify platform ownership and incident two services.
• Proposed rules include payment reductions for multiple procedures.
• Engaging with professional societies amplifies advocacy efforts.

Takeaways

• Stakeholders must comment by September 14 to influence policy.
• Telehealth flexibilities are extended until the end of 2027.
• Modifiers BB and BC will identify platform ownership and incident two services.
• Proposed rules include payment reductions for multiple procedures.
• Engaging with professional societies amplifies advocacy efforts.

In this episode, Terry Fletcher and Sean discuss the complexities of lifestyle medicine, insurance reimbursement, and the importance of understanding what services are covered. They explore how providers can navigate insurance limitations while advocating for patient care.

Key Topics

• Insurance reimbursement for lifestyle medicine
• Medical necessity and insurance coverage
• Billing and coding challenges in healthcare
• Advocating for patient services outside insurance coverage
• Impact of diagnosis on service reimbursement
• Legal considerations in billing non-covered services
• Strategies to appeal insurance denials
• The role of preventive and lifestyle services in healthcare
• Limitations of insurance plans for wellness services
• Provider-patient communication about costs and coverage

This episode focuses on a compliance issue that keeps tripping up practices: incident to billing, split shared visits, and the limits of what medical students can document.

Sean M Weiss and Terry walk through where the rules apply, where they do not, and why using student documentation to support a billable service is not allowed.

Terry also shares a real world question from recent presentations that pushed the conversation into medical student use, supervisory rules, and the risk of stretching billing frameworks beyond their intent. The discussion closes with a cautionary look at fraud, waste, and abuse, plus the importance of proper credentialing and supervision.

Key topics

• Incident to vs. split shared visits
• What counts as a shared service
• Medical student documentation is not billable
• What a teaching physician may use
• Why cut and paste is not allowed
• Students are for education, not revenue
• Employment and supervision requirements still matter
• Telehealth supervision and ancillary services
• Fraud, waste, and abuse concerns