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Healthcare Fraud Shield

WebOnly the HCFS Platform™ is powered by the FWA Precision Engine™. Industry-leading healthcare insurance companies rely on the HCFS Platform™ for Fraud, Waste, and …

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DRG and Clinical Validation Audits: Demystifying the Difference

WebMedical record auditing is an excellent tool for payers to ensure that hospitals are appropriately reimbursed for services rendered. The Office of Inspector General’s …

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Upcoding HCCs–Diabetes

WebWhat is an HCC? An HCC is a Hierarchical Condition Category which is used to calculate risk scores that may predict the future cost of healthcare for enrollees. HCCs …

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Suvorexant and Opioid Withdrawal

WebThe Opioid epidemic continues to plague many individuals resulting in overdoses and in some cases death. According to the CDC, in 2020 almost 75% of drug …

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Decoding Annual Wellness Visits (AWV)

WebThere are two codes used: G0438 – Initial AWV. G0439 – Subsequent AWV. What to look for? Auditors and investigators should: • review claims data to ensure that …

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Season 4, Episode 3: Listen to Maria Seedorff, Healthcare Fraud …

WebMaria is a chiropractor, a Certified Professional Coder, and Accredited Health Care Fraud Investigator and one of our FWA gurus. Go to Healthcare Fraud Shield …

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Keep Your Eyes on Places of Service Codes 02 and 10!

WebPatient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving …

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Coding Crisis Psychotherapy

WebWhat is Crisis Psychotherapy? Crisis Psychotherapy is a session that occurs between the provider and the patient due to a life-threatening or highly complex issue …

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Understanding Interpretive Services

WebHealthcare Common Procedure Coding System (HCPCS) codes that start with the letter T are typically used by Medicaid agencies, Managed Care Organizations …

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2024 Industry Conferences/Webinars

WebHealthcare Payment & Revenue Integrity Congress East * – May 23-24, 2024. National Health Care Anti-Fraud Association, Schemes for Health Care Fraud …

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Unwrapping the Global Surgery Mystery

WebThe global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a …

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Let’s Talk about Modifier – AT – Active Treatment

WebActive treatment basically means a condition is being treated that will improve within a reasonable or expected period of time. Maintenance treatment is meant to …

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Understanding Modifier Q6

WebWhen evaluating and/or auditing claims submitted with modifier Q6, look for the following scenarios which would be considered inappropriate usage of modifier Q6: …

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