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.

Fraud Spotlight: Why Modifier 25 FWA Continues

  • Steve Nesnidal, MD, CPC, AHFI
  • Jun 07, 2023
  • Comments
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A pain management practice will pay $625k from a False Claims Act violation. Similar cases give an importance to Fraud, Waste, and Abuse (FWA) protection, and the use of E/M codes would have detected an abnormality on similar claims. Read more to find out how.

Evaluation and Management with Psychotherapy

  • Steve Nesnidal, MD, CPC, AHFI
  • Sep 26, 2022
  • Comments
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CPT provides distinct codes for reporting face-to-face Psychotherapy with two different approaches. Either an Evaluation and Management (E/M) code can be submitted in tandem with a Psychotherapy add-on code, or a standalone Psychotherapy code can be submitted. Press "Read More" to learn how to use these codes appropriately.

The Latest Three COVID-19 Vaccine Codes from the AMA

  • Steve Nesnidal, MD, CPC, AHFI
  • Feb 02, 2022
  • Comments
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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.

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.

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