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Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform.
to empower your organization
Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts.
Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution.
More than 100 healthcare data sets, with professional support to optimize efficiency and compliance.
Advanced medical coding software designed to expedite claim submission and minimize denials.
from our team of experts
The Latest Three COVID-19 Vaccine Codes from the AMA
On February 1, 2022, the AMA released three more specific COVID-19 CPT Vaccine codes for use in reporting vaccination with Pfizer’s latest toxoid of patients between six months to five years of age. Although these codes have been released, they will not be effective until the date an EUA (Emergency Use Authorization) is granted by the FDA.
Impact of Policy Adjustments on Telehealth Fraud
In May 2021, MedPac provided feedback to Congress regarding their opinions on the effectiveness of the overwhelming 200 healthcare policy changes that Congress and CMS instituted during the interval of January through July 2020, in response to the coronavirus public health emergency. Aside from the obvious and necessary benefits of these changes in response to the pandemic, MedPac raises concerns about the detrimental impact in the realm of fraud in healthcare: “…not all actors in the healthcare system are well-intentioned”.
Audits of Telehealth Services During COVID-19
Relaxed telehealth restrictions is a necessary step to limit potential COVID-19 exposure in physician offices in the emergency period. With this change, unfortunately, the US Justice Department estimates telehealth-related fraud has expanded significantly since early 2020 – approximated at 4.5 billion dollars.