Posted and filed under Fraud, FWA, Healthcare, Medical Record Auditing.

Fraud Spotlight: The Kyphoplasty & The Qui Tam

This week’s Fraud Spotlight article was written by Peggy Glynn, a former OIG Field Agent from Buffalo, NY. Her friendship, insights, and experiences in the OIG are incredible tools for those looking to learn more about fighting healthcare fraud, waste, and abuse. Who is Kyphon Inc., what is a kyphoplasty, and where does the Civil…

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Posted and filed under Coding, Fraud, FWA, Healthcare, Medical Record Auditing.

Fraud Spotlight: Economic Healthcare Fraud Perspectives

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes.  This past week, while having lunch with a friend who knew about my…

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Posted and filed under Fraud, Medical Record Auditing.

Behavioral Health Billing Errors

A 2017 audit fronted by Massachusetts State Senator Suzanne M. Bump revealed over $190 billion dollars in improper or ambiguous payments within MassHealth’s Behavioral Health program. The audit uncovered years of questionable billing practices, lack of administrative oversight, and conflicting understandings of requirements, regulations, and internal policies. The Senator went on the record explaining the…

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Posted and filed under Coding, Community, Medical Record Auditing.

Where To Find Free CEUs

Continuing Education Units (CEU) for healthcare professionals who are credentialed by the AAPC are worth their weight in gold. CEUs are a necessary tool for all medical coders and auditors as they are not only required for certification maintenance, but because they keep professionals current on industry trends. The AAPC has a set of guidelines…

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Posted and filed under Events, FWA, Medical Record Auditing.

ICYMI: 2018 OIG Work Plan Webinar

Advize Health’s first webinar of the new year will be broadcasting live today from 2:00PM EST until 3:30pm EST. The program will break down the 2018 OIG Work Plan and provide an in-depth examination at the OIG (Office of Inspector General) and their efforts in the fight against fraud. From mandatory requirements, to laws and…

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Posted and filed under Compliance, Fraud, FWA, Healthcare, Medical Record Auditing.

Risky Retrievals

For years, whenever we began launching a medical record review project, clients and physicians alike would ask us the same question: Why can’t you come onsite to pick up the requested records? The easy answer would have been to say that we simply hadn’t performed record retrievals before, but we had vested interest in doing…

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Posted and filed under Coding, Medical Record Auditing, Payers.

Mammography Coding

In honor of Breast Cancer Awareness Month, we’ve decided to release a brief reminder to not only schedule a routine mammogram, but to recall the 2017 Mammogram Coding Changes. Mammography Coding The Centers for Medicare and Medicaid Services (CMS) announced in November 2016’s final rule that they would not be able to accommodate the new…

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Posted and filed under Coding, Medical Record Auditing.

2017 UDT Codes Refresher

As of January 1, 2017, providers who administer controlled substance testing should apply the proper and most current guidelines for L35724 – Controlled Substance Monitoring and Drugs of Abuse. Best Practices Ensure that services and procedures reported on submitted claims match the service(s) ordered by the physician. Remember that a maximum of one presumptive and…

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Posted and filed under Compliance, Medical Record Auditing.

Sign, Seal, Deliver: Provider Signature Requirements

To a physician, providing authentication may appear as yet another inconvenience or hindrance to productivity in the midst of the already chaotic audit process – but it’s the difference between being reimbursed and having your claims denied. For the purpose of a medical record audit, Medicare requires that any services provided be authenticated within the…

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Posted and filed under Coding, Medical Record Auditing, Payers.

Think Twice Before Appending Modifiers

Coding Modifiers In the English language, a modifier is used to describe the who, what, how, why, and/or where of a situation. Coding modifiers perform the same role for medical coders and billers. These types of modifiers further describe procedure codes without altering its original definition. Modifiers can be found in both the CPT and…

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