Context to Showcase FWA Solutions at NHCAA Conference in Dallas, TX

  • Kate Armbruster
  • Nov 17, 2014
  • Comments

  Context 4 Healthcare Inc. will showcase its Fraud, Waste & Abuse (FWA) solutions as an exhibitor at the National Health Care Anti-Fraud Association (NHCAA) 2014 Annual Training Conference taking place November 18 - 21, 2014 at the Hyatt Regency Dallas in Dallas, TX. The NHCAA Institute for Health Care Fraud Prevention's Annual Training Conference (ATC) is the organization's premiere annual event, recognized industry-wide as the nation's leading health care anti-fraud forum. At Conte ...

Detect Unusual Patterns in Service & Patient Volume in All Specialties

  • Cindy Gallee, JD, RHIA, CHC
  • Nov 14, 2014
  • Comments

Payers should not neglect reviewing dental claims for fraud, waste and abuse. An Office of Inspector General (OIG) report released this month found questionable billing for pediatric dental services, including dentists who provided an aberrant number of services per day and dentists performing an unusual number of services per patient per visit. Also, the OIG found inappropriate billed claims for behavior management services. Though the findings are important for reviewing dental claims, they a ...

Big Change This Fall! MUE Allows 2 E/M Codes Billed for the Same Day

  • Margaret Klasa DC, APN BC
  • Nov 03, 2014
  • Comments

  In the past, Medicare has allowed only one Evaluation and Management (E/M) visit per day. Now, as of October 1, 2014, the Medically Unlikely Edits (MUE) allows you to report two medically necessary E/M visits per patient, per day. (Although until you receive notification from your Medicare carrier, it would be reasonable to follow existing coding guidelines.) There are episodes when a patient sees a provider in the morning and for a different problem unrelated to the first presents late ...

Why Quashing Kwashiorkor Overpayments is a Good Lesson for Any Payer

  • Cindy Gallee, JD, RHIA, CHC
  • Oct 31, 2014
  • Comments

If you are seeing claims for the treatment of Kwashiorkor, you may want to conduct a review of each claim containing this diagnosis. In OIG reports filed last month, a review of 305 claims with the diagnosis of Kwashiorkor from three different institutions concluded that 100% of them did not meet billing requirements. This resulted in an overpayment to these institutions of $876,950 in total. Earlier this year, OIG reviewed 891 claims from nine other institutions with this diagnosis, with simi ...

Tips to Modify Your Modifier Usage: Bundling & Unbundling Compliance

  • Cindy Gallee, JD, RHIA, CHC
  • Oct 14, 2014
  • Comments

"Unbundling" is a hot topic within the healthcare community and is considered fraudulent if done intentionally to maximize payment. Unbundling occurs when multiple CPT codes are billed for the component parts of a procedure when there is a single code available that includes the complete procedure.The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI or CCI) edits to prevent inappropriate payment of services that should not be reported ...

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