Detect FWA Using Patterns in Procedure & Diagnosis Code Pairings
by Cindy Gallee, JD, RHIA, CHC Payers can detect fraudulent billing schemes by analyzing certain CPT codes that are used in conjunction…
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Smile! Context to Showcase Dental UCR as Exhibitor at NADP Conference
by Kate Armbruster Context4 Healthcare will showcase its Dental UCR solution as an exhibitor at the National Association of Dental Plans (NADP) Converge…
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Tips for Payers to Improve Monitoring Hospital Admissions for Fraud
by Cindy Gallee, JD, RHIA, CHC On August 4, 2014, the Department of Justice announced a settlement with Community Health…
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Context is Headed to the Plexis 2014 Users Conference in Ashland, OR
by Kate Armbruster Context4 Healthcare will showcase its FirstPass™ claim editing solution as an Integrated Partner exhibitor at the Plexis…
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CERT Program Monitors CMS FFS Improper Payments – $36 Billion in 2013
by Margaret Klasa DC, APN BC On July 9, 2014, the U.S. government was subject to a frenzy of media…
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Announcing Context’s New Blogs! Expert Analysis for Payers & Providers
by Kate Armbruster Context4 Healthcare is excited to announce the launch of three brand-new blogs designed to explore and analyze issues…
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4 Ways for Payers to Detect Fraudulent Therapy Services
by Cindy Gallee, JD, RHIA, CHC In a July 2014 news release, the Department of Justice announced the guilty plea…
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RAC Audit Identifies Overpayments for Billing Incorrect DME Codes
by Margaret Klasa DC, APN BC RAC Region C contractor Connolly posted 2 automated reviews for DME providers on April…
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Use of Clinical Editing to Identify Medical Necessity for Cetuximab
by Margaret Klasa DC, APN BC RAC Region B contractor CGI posted a semi-automated review on March 26, 2014, for…
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The High Cost of Spinal Surgery – Necessary or Potential Fraud?
by Cindy Gallee, JD, RHIA, CHC The number of spinal surgeries done in the U.S. has increased in a recent…
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Avoid Reimbursement Issues Due to Misused E/M Codes & Modifier -25
by Cindy Gallee, JD, RHIA, CHC Payers should pay particular attention to physician claims utilizing modifier 25 because this modifier…
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