Hcfraudshield.com

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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The Value of Prepayment Software and Claims Reviews

WEBFirst, let’s introduce you to Healthcare Fraud Shield’s new Director of Prepayment Review, Alexandria Denton. Alex’s work has spanned across industries in …

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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 …

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Scaling and Planing Concerns

WEBScaling is the process of removing plaque and tarter from below the gumline. Planing (Root Planing or Curettage) is when the patient’s tooth root is smoothed out …

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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 …

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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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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: …

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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 …

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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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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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