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 | 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...
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...
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...
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...
by Advize Admin | Sep 18, 2020 | Coding, Dental, Fraud, FWA
This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column next week for more examples of dental fraud from real cases! This article points out some basics of dental misconduct – fraud. A dentist who...
by Advize Admin | Nov 22, 2019 | Coding, Compliance, Fraud, FWA, Healthcare
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...
by Advize Admin | Jan 30, 2017 | Coding, ICD-10
Since the 2014 Patient Protection and Affordable Care Act (ACA), physicians can be reimbursed for the preventative services of tobacco use screening and cessation counseling. It is a well-known fact that smoking has negative effects on your healthy,but did you know...
by Advize Admin | Jan 9, 2017 | Coding, Medical Record Auditing
If you’re reading this article, chances are you already know what HCC Coding is – but we’ll give you a refresher anyway. Hierarchical Condition Category (HCC) and Risk Adjustment Coding is a CMS-mandated payment model. This particular model works to identify those...
by Advize Admin | Oct 4, 2016 | Dental
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...
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