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Healthcare Fraud Shield

WEBOnly the HCFS Platform™ is powered by the FWA Precision Engine™. Industry-leading healthcare insurance companies rely on the HCFS Platform™ for Fraud, Waste, and …

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Upcoding HCCs–Diabetes

WEBWhat is an HCC? An HCC is a Hierarchical Condition Category which is used to calculate risk scores that may predict the future cost of healthcare for enrollees. HCCs …

Category: Health Go Health

Keep Your Eyes on Places of Service Codes 02 and 10!

WEBLately, it feels like every week there is a new procedure code, but do you pay attention to new place of service codes? Most are familiar with Place of Service 02, but …

Category: Health Go Health

Understanding Modifier Q6

WEBWhen evaluating and/or auditing claims submitted with modifier Q6, look for the following scenarios which would be considered inappropriate usage of modifier Q6: …

Category: Health Go Health

Understanding Interpretive Services

WEBHealthcare Common Procedure Coding System (HCPCS) codes that start with the letter T are typically used by Medicaid agencies, Managed Care Organizations …

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Unwrapping the Global Surgery Mystery

WEBThe global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a …

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DRG and Clinical Validation Audits: Demystifying the Difference

WEBMedical record auditing is an excellent tool for payers to ensure that hospitals are appropriately reimbursed for services rendered. The Office of Inspector General’s …

Category: Medical Go Health

Decoding Annual Wellness Visits (AWV)

WEBThere are two codes used: G0438 – Initial AWV. G0439 – Subsequent AWV. What to look for? Auditors and investigators should: • review claims data to ensure that …

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Let’s Talk about Modifier – AT – Active Treatment

WEBHow many of us went to a chiropractor only once? How often did you go when you first initiated chiropractic treatment vs. months later? Do you know if you are …

Category: Health Go Health