by Advize Admin | Sep 11, 2024
OIG Roundtable (Formerly Retro Fraud) Episode 94: Is Adding a Diagnoses to a Medicare Advantage Patient FWA or a Positive Step in Social Determinants of Health (SDOH) Play Episode Pause Episode Mute/Unmute Episode Rewind 10 Seconds 1x Fast Forward 10 seconds 00:00 /...
by Chia Gemmato | Oct 27, 2023 | Advize News
Advize Health is thrilled to welcome Ashlee Heath to the Advize team as Director, Program Integrity. Ashlee is a passionate and experienced leader with more than a decade of healthcare experience in coding compliance and fraud, waste and abuse prevention, detection,...
by Advize Admin | Aug 4, 2023 | Community, FWA
On a recent trip to South Florida, I came across some very interesting sights that gave me pause. The first was the combination of an Adult Day Care/Auto Garage, as pictured. The second was a similar combo of Home Health Care in the same storefront as a Guns/Ammo...
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 | Jul 7, 2023
OIG Roundtable (Formerly Retro Fraud) Episode 38: Interviewing & the Importance of Consistency Play Episode Pause Episode Mute/Unmute Episode Rewind 10 Seconds 1x Fast Forward 10 seconds 00:00 / 23:57 Subscribe Share Spotify RSS Feed Share Link Embed Download file...
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...
by Advize Admin | May 5, 2023
OIG Roundtable (Formerly Retro Fraud) Episode 31: Challenges of Managing an SIU Play Episode Pause Episode Mute/Unmute Episode Rewind 10 Seconds 1x Fast Forward 10 seconds 00:00 / 33:20 Subscribe Share Spotify RSS Feed Share Link Embed Download file | Play in new...
by Advize Admin | Mar 10, 2023
OIG Roundtable (Formerly Retro Fraud) Episode 24: Quick Hello from the ABA Health Law Emerging Issues in Healthcare Law Conference Play Episode Pause Episode Mute/Unmute Episode Rewind 10 Seconds 1x Fast Forward 10 seconds 00:00 / 12:44 Subscribe Share Spotify RSS...
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