Medical Record Auditing | Advize Health

Uncovering the Troubling Reality of Improper Payments in COVID-19 Programs: People with Insurance got COVID Services Paid by HRSA?!! You Don’t Say?

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...

Fraud Hunters: One Hit “Wonders”

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...

Did Your Health Plan Rip Off Medicare?

by Advize Admin | Jan 27, 2023 | Compliance, FWA, Medical Record Auditing

Today, KHN has released details of 90 previously secret government audits that reveal millions of dollars in overpayments to Medicare Advantage health plans for seniors. The audits, which cover billings from 2011 through 2013, are the most recent financial reviews...

MA and Risk-Scoring, We Can Do Better (and Advize does)

by Advize Admin | Dec 2, 2022 | Compliance, FWA, Medical Record Auditing, OIG Files

When you first open this article, the most glaring of things is the time frame from which the audit was derived. 2011-2013 data is at this point so aged, the calculation of $1,000 per patient enrolled in a Medicare Advantage (MA) as the overcharged amount is simply...

Audits — Hidden Until Now — Reveal Millions in Medicare Advantage Overcharges

by Advize Admin | Dec 2, 2022 | Coding, FWA, Medical Record Auditing

Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some plans overbilling the government more than $1,000 per patient a year on average. Summaries of the 90 audits, which...

Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging

by Advize Admin | Jul 8, 2022 | FWA, Healthcare, Medical Record Auditing

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Witnesses sharply criticized...

Auditing Medical Records for Medical Necessity

by Advize Admin | Aug 27, 2021 | Medical Record Auditing

A little background, one of areas where Advize provides consulting services is in the medical record review space. We have been providing this service to clients for over 20 years, both proactively, and reactively. Our CEO, Jeanmarie Loria, was actually a...

10 Ways to Avoid an Audit

by Advize Admin | May 20, 2021 | Compliance, Medical Record Auditing

As new technologies progress more and more payers are actively deploying AI capable systems. This shift is now producing more audits of physicians than ever before and directly contributing to higher rates of denials. Audits take time and...

3 Quick Tips to Avoid an Audit

by Advize Admin | Dec 9, 2020 | Fraud, FWA, Healthcare, Medical Record Auditing

Healthcare providers have a lot on their minds. Between daily rounds, patient care, and an ongoing global pandemic – it’s not easy to stay on top of administrative tasks like documentation and medical record maintenance. Even so, medical record review is a critical...

Dental Fraud: Standard of Care Violations

by Advize Admin | Oct 9, 2020 | Dental, Fraud, FWA, Medical Record Auditing

Even more than money … what about the standard of care? This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column for more expert insights from our network of providers, investigators, and fraud...