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Find news and solutions for healthcare payers and providers. Recognize and avoid potential fraud, waste, and abuse scenarios. Real-time clinical claim editing are analyzed to maximize provider reimbursements.

Impact of the COVID-19 Pandemic on Healthcare Fraud

  • Steve Nesnidal, MD, CPC, AHFI
  • Apr 07, 2021
  • Comments
Stop Fraud Image - Large

During the pandemic, healthcare claim fraud prevails as new fraud schemes develop and adapt to the changes in healthcare guidelines enacted, so providers can continue to treat patients. Two major areas of FWA expansion during the pandemic include Telehealth and COVID-19-related laboratory testing add-on services.

Janssen Single-Dose COVID-19 Vaccine is Pending FDA Emergency Use Authorization

  • Steve Nesnidal, MD, CPC, AHFI
  • Feb 23, 2021
  • Comments
iStock-vaccineresearch_smaller

Janssen Biotech, Inc. applied to the FDA for Emergency Use Authorization (EUA) of its single-dose COVID-19 vaccine, which may be a highly desirable weapon used to fight the virus based on characteristics and efficacy data.

Effective dates now known for Pfizer and Moderna vaccines, AstraZeneca vaccine coming

  • Steve Nesnidal, MD, CPC, AHFI
  • Dec 24, 2020
  • Comments
COVID Vaccine

Pfizer and Moderna Covid vaccine codes receive effective dates, AstraZeneca vaccine assigned procedure codes but not yet effective.

New COVID-19 Vaccine Codes Released, Effective Pending FDA Approval

  • Steve Nesnidal, MD, CPC, AHFI
  • Nov 17, 2020
  • Comments
COVID Vaccine

AMA has released a series of new, unique CPT Category I codes for use in reporting COVID-19 FDA approved vaccines. The codes will become active as soon as the FDA approves the first two COVID-19 vaccines produced by Pfizer and Moderna.

CMS Adds New HCPCS COVID-19 Lab Code

  • Steve Nesnidal, MD, CPC, AHFI
  • Oct 21, 2020
  • Comments
COVID Test Neg

CMS is adjusting its payment policy for COVID-19 laboratory tests starting in Jan 1, 2021 in order to incentivize high throughput COVID-19 laboratory test results and ensure turnaround of results are provided in a clinically meaningful timeframe.

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