FWA Briefs

Reviewing patterns of overpayment from providers who incorrectly select modifiers when billing for insurance.

Addressing and diving into the issue of hospice fraud in the United States, specifically with claims submitted for those who don't qualify for hospice or those who didn't receive hospice.

Using the RAND Corporation's newest study to understand payer questions involving Medicare Reference-based Pricing.

Dr. Steve Nesnidal of Context 4 Healthcare, Inc. presented at the 2023 NHCAA Annual Training Conference on Overutilized High-level Drug Testing, focused on Small Fees with Large Overpayments. Dr. Nesnidal goes into depth about specific cases where aberrant providers intentionally billed a higher amount of the higher-level codes.

In our latest blog, we discuss a recent OIG report that found Medicare could have saved millions of dollars by monitoring providers who billed the highest reimbursable codes. It shows how certain code descriptions were miscounted by providers, causing higher reimbursements that weren't owed. Click below to learn and read more.