FWA Briefs

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.

NPI Guidance Can Help Your FWA Detection

  • John Danza
  • Jul 24, 2023
  • Comments
telehealthfraud-small

The Centers for Medicare & Medicaid Services (CMS) recently released new guidance that may affect certain providers wanting to obtain an NPI if they don’t already have one. These guidelines are important for you and your health plan to have protection against fraud, waste, or abuse (FWA) in your claims.

CMS Adds and Updates Place of Service Telemedicine Codes

  • Steve Nesnidal, MD, CPC, AHFI
  • Feb 11, 2022
  • Comments
KeyboardMedical

On January 1, 2022, CMS’s Place of Service (POS) Workgroup added new POS code 10, with description "Telehealth Provided in Patient’s Home". Simultaneously, the established POS code 02 description was changed to "Telehealth Provided Other than in Patient’s Home".

Fighting Fraud in Medical Nutrition Therapy

  • Steve Nesnidal, MD, CPC, AHFI
  • Apr 27, 2021
  • Comments
Nutrition

The role of nutrition in chronic disease management is especially crucial, as it is a modifiable risk factor for many conditions such as chronic renal failure (CRF), diabetes mellitus (DM), obesity and coronary artery disease (CAD). Payers who bear significant long-term healthcare utilization burdens due to obesity and cardiovascular risk factors may determine that Medical Nutrition Therapy (MNT) preventive coverage is a cost-effective policy approach for their beneficiaries.

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