Drugs Used to Treat HIV Have Become Targets for Fraud Investigations

  • Cindy Gallee, JD, RHIA, CHC
  • Aug 29, 2014
  • Comments

Antiretroviral drugs, used to treat Human Immunodeficiency Virus (HIV), have recently come under scrutiny by the Office of Inspector General (OIG) as a target for fraud, waste and abuse. According to the World Health Organization, in the year 2013 there were approximately 35 million people living with HIV, and an estimated 12 million HIV patients undergoing treatment with antiretroviral therapy. Antiretroviral drugs were first used to treat HIV in 1987, and today there are approximately 30 ap ...

Context is on the Oregon Trail...to the Plexis 2014 Users Conference!

  • Kate Armbruster
  • Aug 18, 2014
  • Comments

Context 4 Healthcare will showcase its FirstPass™ claim editing solution as an Integrated Partner exhibitor at the Plexis 2014 Users Conference taking place September 14 - 18 in Ashland, OR. Context’s FirstPass™ claim editing solution is integrated with the Plexis claim management system and provides users with direct access to edit results via a real time web services interface. The  FirstPass™ professional and institutional edits are updated weekly and are autom ...

Detect FWA Using Patterns in Procedure & Diagnosis Code Pairings

  • Cindy Gallee, JD, RHIA, CHC
  • Aug 15, 2014
  • Comments

Payers can detect fraudulent billing schemes by analyzing certain CPT codes that are used in conjunction with ICD diagnosis codes and determining aberrant patterns , such as: a provider who bills a certain CPT code with the same diagnosis every time; a provider billing a certain CPT code with a diagnosis that does not support medical necessity; or an illogical number of a certain procedure billed within a time frame. An aberrant pattern, though not always fraudulent, can be investigated and th ...

Smile! Context to Showcase Dental UCR as Exhibitor at NADP Conference

  • Kate Armbruster
  • Aug 11, 2014
  • Comments

Context 4 Healthcare will showcase its Dental UCR solution as an exhibitor at the National Association of Dental Plans ( NADP ) Converge 2014 conference, taking place September 15 – 18, 2014 near Orlando, FL. NADP’s Converge 2014 conference will bring together the leading experts, panelists, and vendor resources within the dental benefits industry. Although this is the first year Context has been included as a vendor at the NADP Converge conference, the year 2014 marks the 15 th ye ...

Tips for Payers to Improve Monitoring Hospital Admissions for Fraud

  • Cindy Gallee, JD, RHIA, CHC
  • Aug 11, 2014
  • Comments

On August 4, 2014, the Department of Justice announced a settlement with Community Health Systems, Inc. (CHS) for $98.15 million to satisfy allegations CHS improperly billed Medicare, Medicaid and Tricare for inpatient admissions that should have been billed as outpatient or observation services. CHS is the largest operator of acute care hospitals in the country, which currently number 206 hospitals in 29 states. The lawsuit specifically alleges that CHS, through corporate policy, encouraged in ...

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