FWA Briefs

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

The Centers for Medicare & Medicaid Services (CMS) recently released new guidance that may affect certain providers wanting to obtain an NPI if they don’t already have one. These guidelines are important for you and your health plan to have protection against fraud, waste, or abuse (FWA) in your claims.

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. The new CDT code additions for 2021 will include nine (9) new codes for image capture only.

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.

Overutilization in Healthcare is a problem which has been estimated to cost in the range of hundreds of billions of US dollars every year. Despite historically spending more than double per person on healthcare than the average developed country, our outcomes have not been significantly better.