On August 15, 2014, the Centers for Medicare & Medicaid Services (CMS) introduced four new Healthcare Common Procedure Coding System (HCPCS) modifiers that will clarify the use of modifier -59. The modifier -59 description implies that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. Provider specialties and others often use it to override edits found in Medicare’s National Correct Coding Initiativ ...

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 ...

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 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 ...

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 ...