FWA Briefs

Reviewing patterns of overpayment from providers who incorrectly select modifiers when billing for insurance.

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.

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".

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.