Dr. Cicio has been in the podiatry and FW industry for over 40 years and has a wealth of experience and insight in the field of podiatry, the fraud schemes and some tricks, tips and tools that can be utilized to ferret out FWA in your payment integrity programs.
Eric conducted numerous podiatry fraud investigations during his career at the OIG (and even here at Advize), including numerous criminal, civil and administrative investigations resulting in millions of dollars being brought back to the Medicare and Medicaid programs. This is a definite “not to miss” discussion.
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Post Webinar Update
As we were discussing when we lost Gary’s feed, there are a number of Current Procedure Terminology (CPT) codes that investigators and auditors can begin to review to data mine for the anesthesiology fraud scheme wd discussed during our LinkedIn Live event. Here is a great guide to use for doing some of that proactive data analytic work:
- Identify Anesthesiologists / Anesthesia Groups BY TAX ID
- Look for SAME Tax ID ( not NPI ) billing Code(s) from Anesthesia CPT code series 00100 – 01999
- That SAME Tax ID ALSO billing for Code(s) from Peripheral Nerve Block CPT code series 64400 – 64453.
- SAME member
- SAME Date Of Service ( DOS )
Also:
- Even from a Coding perspective, ALL 64400 – 64453 codes are BUNDLED in ALL 00100 – 01999 codes.
- Configure claims systems to deny 64400 – 64453 for same Tax ID, same member and same DOS when billed with 00100 – 01999 service(s).
** DO NOT ALLOW MODIFIER -59 OVERRIDE.
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