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.

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.

CDT 2021 Updates Include New Codes for Coronavirus and Vaping

  • Steve Nesnidal, MD, CPC, AHFI
  • Aug 13, 2020
  • Comments
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The American Dental Association® (ADA) will add 28 new CDT codes effective January 1, 2021, along with seven (7) code revisions, four (4) code deletions and 22 editorial changes. Among the new CDT code additions for 2021 are two (2) new coronavirus testing codes and a code related to counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance use.

Alert: New COVID-19 ICD-10-CM Diagnosis Code, CPT® and HCPCS Codes

  • Steve Nesnidal, MD, CPC, AHFI
  • Jun 02, 2020
  • Comments
HealthcareTeam

In response to the Novel Coronavirus pandemic, a new ICD-10-CM code was moved up from previous posted effective date of October 1, 2020. The new ICD-10-CM diagnosis code, U07.1, is effective April 1, 2020.

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