by Advize Admin | Jul 28, 2023 | FWA, Medical Record Auditing
There is absolutely nothing in this report that should be interesting, shocking, or otherwise reflective of surprise. $784 million in improper payments is estimated to have been made to providers as it relates to COVID-19. Claims were submitted to the uninsured...
by Advize Admin | Jul 14, 2023 | FWA
Self doubt is a necessary part of the process when making claim determinations. As a reviewer, you have the ultimate decision-making authority as to whether a re-opened claim should be denied and the money recouped. You should be asking yourself whether the...
by Advize Admin | Jul 7, 2023 | FWA, Medical Record Auditing
Newly approved procedure codes, devices and DME are like the watering holes on the Serengeti. They are gathering spots for fraudsters and great hunting grounds for those looking to identify and stop the FWA. As a fraud hunter, you must follow the data trends to...
by Advize Admin | Jun 22, 2023 | FWA, Healthcare
If you are an avid reader of our newsletter or blogs, you know that we focus on payment integrity, program integrity, fraud waste and abuse, and the cost/quality of healthcare. We are often talking about the business behind healthcare, and not necessarily the doctors...
by Advize Admin | Jun 16, 2023 | FWA, Healthcare
For those that remember Solaraze, it is one of the name brands for Diclofenac. Diclofenac is commonly known today as Voltaren. In 2018, the OIG conducted a study that reflected that there were some strong fraud indicators on the off-label use of Diclofenac (under...
by Advize Admin | May 26, 2023 | Coding, FWA
Within the past few weeks, we have seen at least two of the large payors seek to institute policies that would require providers to submit their medical records when an Evaluation and Management (E&M) is appended with Modifier 25. While not having a discussion on...
Recent Comments