Posted and filed under Coding, Dental, Fraud, FWA.

Dental Fraud: Isolated or a Pattern?

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 bills for services not performed is committing fraud.  For example, billing for the…

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Posted and filed under Coding, Compliance, Fraud, FWA, Healthcare.

Fraud Spotlight: Provider Awareness & Compliant Billing

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. This past week, I had the pleasure of presenting a webinar to approximately…

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Advize Health Online CPC Training Course

Self Directed/Online 6 Weeks – Our Self-Directed online course is open for 4 months after you begin. Experience the independence of self-study with the security of instructor assistance.  Instructor is available via email and student may schedule 1 hour with the instructor each week to discuss issues/practice test questions for 5 weeks.  Instructor will follow…

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Posted and filed under Coding, ICD-10.

Through the Smoke: Coding for Tobacco Cessation Counseling

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 that if you require surgery while maintaining your smoking habit, that the risk of…

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Posted and filed under Coding, Medical Record Auditing.

Keep M.E.A.T. on Your List for a Healthy Audit

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 with chronic and other serious illnesses and prescribes a risk factor score to…

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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 Medical Record Auditing.

The Importance of Medical Necessity in Medical Coding

Medical necessity documentation, or lack of it, is one of the most common reasons for claim denials. For a service to be considered medically necessary, it must be reasonable and necessary to diagnosis or treat a patient’s medical condition. When submitting claims for payment, it is the diagnosis codes reported with the service that tells…

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Posted and filed under Coding.

This Season’s Flu Epidemic

As temperatures continue to drop this winter season, the number of runny noses and sneezes keeps on climbing. Flu season is still going strong, persevering through the flurry of snow storms and keeping people in bed for up to two weeks at a time. If you have a child, you may hear about their classmates…

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Advize Health Risk Adjustment Coding Webinar

Advize Health is here to advise you! We are happy to announce that Advize will be launching webinars to supplement our other educational services monthly.  Our webinars will be delivered by our own knowledgeable senior auditors.  The next webinar will be on January 14th from 2:00-3:30pm and the topic is Health Risk Adjustment Coding. This webinar is free…

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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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