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.

Evaluation and Management with Psychotherapy

  • Steve Nesnidal, MD, CPC, AHFI
  • Sep 26, 2022
  • Comments
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CPT provides distinct codes for reporting face-to-face Psychotherapy with two different approaches. Either an Evaluation and Management (E/M) code can be submitted in tandem with a Psychotherapy add-on code, or a standalone Psychotherapy code can be submitted. Press "Read More" to learn how to use these codes appropriately.

CMS Adds and Updates Place of Service Telemedicine Codes

  • Steve Nesnidal, MD, CPC, AHFI
  • Feb 11, 2022
  • Comments
KeyboardMedical

On January 1, 2022, CMS’s Place of Service (POS) Workgroup added new POS code 10, with description "Telehealth Provided in Patient’s Home". Simultaneously, the established POS code 02 description was changed to "Telehealth Provided Other than in Patient’s Home".

The Latest Three COVID-19 Vaccine Codes from the AMA

  • Steve Nesnidal, MD, CPC, AHFI
  • Feb 02, 2022
  • Comments
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On February 1, 2022, the AMA released three more specific COVID-19 CPT Vaccine codes for use in reporting vaccination with Pfizer’s latest toxoid of patients between six months to five years of age. Although these codes have been released, they will not be effective until the date an EUA (Emergency Use Authorization) is granted by the FDA.

Impact of Policy Adjustments on Telehealth Fraud

  • Steve Nesnidal, MD, CPC, AHFI
  • Sep 10, 2021
  • Comments
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On May 19, 2021, the Medicare Payment Advisory Commission (MedPac) provided feedback to Congress regarding their opinions on the effectiveness of the overwhelming 200 healthcare policy changes that Congress and CMS instituted during the interval of January through July 2020, in response to the coronavirus public health emergency. Aside from the obvious and necessary benefits of these changes in response to the pandemic, MedPac raises concerns about the detrimental impact in the realm of fraud in healthcare: “…not all actors in the healthcare system are well-intentioned”.

Audits of Telehealth Services During COVID-19

  • Steve Nesnidal, MD, CPC, AHFI
  • Jun 29, 2021
  • Comments
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Relaxed telehealth restrictions is a necessary step to limit potential COVID-19 exposure in physician offices in the emergency period. With this change, unfortunately, the US Justice Department estimates telehealth-related fraud has expanded significantly since early 2020 – approximated at 4.5 billion dollars.

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