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.

Potential Overpayment Patterns: Non-Physician Assistant at Surgery

  • Steve Nesnidal, MD, CPC, AHFI
  • Aug 15, 2024
  • Comments
PhysicianNotes_Cropped_1024x768

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

The Federal Hospice Fraud Problem in the United States

  • Steve Nesnidal, MD, CPC, AHFI
  • Jun 25, 2024
  • Comments
DoctorwSeniorPatient_originalsize

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.

Medicare Reference-based Pricing RAND Study

  • John Danza
  • Jun 11, 2024
  • Comments
Keyboard

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

Overutilized High-level Drug Testing: Small Fees, Large Overpayments

  • Steve Nesnidal, MD, CPC, AHFI
  • Nov 17, 2023
  • Comments
Thumbnail7DrSteve

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.

Subscribe to Our Blog:

Connect With Us

Authors


Proudly Affiliated with:

Proud_Members_Logo_250X100   National Association of Dental Plans Member   FedRAMP  Amazon Web Services