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.

Bad Coding: A Fine Line Between Error And FWA

  • Steve Nesnidal, MD, CPC, AHFI
  • Sep 17, 2024
  • Comments
Monitoring Claims for Fraud-canstockphoto25652629

Examining the difference between diagnosis codes that are applied correctly for reimbursements or was done with the intent to increase the amount they are paid. We review some of the more common coding errors that are typically identified.

Why Fraud Analytics Are Important to You

  • John Danza
  • Oct 17, 2022
  • Comments
Man Working on Computer

A multi-million dollar scheme serves as a prime example to the benefits of Fraud, Waste, and Abuse (FWA) protection. The story of a doctor performing an alarmingly high amount of surgeries not typically conducted by their specialty is awakening to the need for robust safeguarding solutions.

Evaluation and Management with Psychotherapy

  • Steve Nesnidal, MD, CPC, AHFI
  • Sep 26, 2022
  • Comments
iStock-143175979

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".

Effective dates now known for Pfizer and Moderna vaccines, AstraZeneca vaccine coming

  • Steve Nesnidal, MD, CPC, AHFI
  • Dec 24, 2020
  • Comments
COVID Vaccine

Pfizer and Moderna Covid vaccine codes receive effective dates, AstraZeneca vaccine assigned procedure codes but not yet effective.

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