Posted and filed under Compliance.

The Corporate Practice of Medicine

Recently, we were contacted by the Chief Financial Officer (CFO) of a medical group that provides primary care, urgent care and podiatric care to patients at several locations. The business operates as a corporate practice of medicine. The CFO had no prior healthcare experience. The Chief Operating Officer (COO) also had no prior healthcare experience….

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: The Curious Case of EOB/EOMB

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. Explanation of Benefits (EOB). Explanation of Medicare Benefits (EOMB). For those of you…

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Posted and filed under Coding, Medical Record Auditing.

Overview of Colonoscopy Coding

Diagnostic Colonoscopy A diagnostic colonoscopy is a test performed as a result of an abnormal finding, sign, or symptom (such as diarrhea, abdominal pain, etc.). Factors for Consideration: Symptoms before the procedure such as a change in bowel habits, rectal bleeding, etc. Findings during the procedure (polyp, cancer, diverticulosis, etc.) Personal history of cancer or…

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CPT 2017 Updates Webinar

Advize is here to advise you! Please join Advize Health on December 20th, 2016 for an exclusive webinar on the CPT 2017 Updates. Advize Health’s QA Specialist Melissa Jewett, CPC, CPMA, will guide attendees through all of the new additions, deletions, and revisions to Current Procedural Terminology code sets. This complimentary webinar is worth 1.5…

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Posted and filed under Dental.

Dental Sensitivity and CDT Utilization

You know the story well. In fact, you’ve probably experienced it at some point in your life. That excruciating, brain-rattling pain that overwhelms you while you’re drinking hot coffee or taking a bite of ice cream. The pain and hyper sensitivity that a week of Sensodyne can’t compete with. But just in case you’re lucky…

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Posted and filed under Healthcare, ICD-10.

Meet PAM, the Amoeba in Your Backyard

The Florida Health Department has been busy this summer, with this year’s fourth reported case of primary amebic meningoencephalitis (PAM) striking an undisclosed patient. PAM is an infection caused by a parasitic amoeba known as Naegleria fowleri, a parasite that thrives in warm freshwater environments. Florida, known for its subtropical climate and wetland ecosystem, has…

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

How Much Are Your Policies Costing You?

A medical record audit can reveal over-payments for up-coding, incorrect numbers of units billed, and the abuse of modifiers – just to list a few. Given the popularity of such indiscretions, what is being done after the money is recovered? Do you intend on data mining again in six months, hoping that the provider will…

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Posted and filed under Coding, Healthcare.

Critical Care and What it Means

CPT Defines critical care as the direct delivery, by a physician(s) or other qualified health care professional, of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems in such that there is a high probability of imminent or life threatening deterioration…

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