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
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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.

2021 Dental CDT Code Changes Include New Image Capture Only Codes

  • Steve Nesnidal, MD, CPC, AHFI
  • Jul 13, 2020
  • Comments
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The American Dental Association® (ADA) will add 28 new CDT codes effective January 1, 2021, along with seven (7) code revisions, four (4) code deletions and 22 editorial changes. The new CDT code additions for 2021 will include nine (9) new codes for image capture only.

Alert: New COVID-19 ICD-10-CM Diagnosis Code, CPT® and HCPCS Codes

  • Steve Nesnidal, MD, CPC, AHFI
  • Jun 02, 2020
  • Comments
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In response to the Novel Coronavirus pandemic, a new ICD-10-CM code was moved up from previous posted effective date of October 1, 2020. The new ICD-10-CM diagnosis code, U07.1, is effective April 1, 2020.

Combating Overutilization of Healthcare Resources

  • Steve Nesnidal, MD, CPC, AHFI
  • Feb 04, 2019
  • Comments
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Overutilization in Healthcare is a problem which has been estimated to cost in the range of hundreds of billions of US dollars every year. Despite historically spending more than double per person on healthcare than the average developed country, our outcomes have not been significantly better.

Keeping a watchful eye on telehealth claims

  • Cindy Gallee, JD, RHIA, CHC
  • Jun 05, 2018
  • Comments
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Telemedicine has grown significantly in recent years due to new technologies and consumer demand. Payer reimbursement policies, on the other hand, are slow to adapt to the new services.

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