FWA Briefs

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.

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.