Coronavirus Creates Cornucopia of Fraud

Published: Wed, 07/01/20

The COVID-19 crisis in the United States has opened vast opportunities for fraud of every type. The scale and scope of COVID-related criminal activity is so vast, we need to take an Aristotelian approach and separate it into categories.

Coronavirus: AMA releases new CPT code for antigen tests

The American Medical Association (AMA) has a release an update to the Current Procedural Terminology (CPT) which includes a new code for reporting antigen testing of patients suspected to be infected with COVID-19.

How Cleveland Clinic created a telehealth team and new documentation to tackle coding, billing changes

When CMS issued sweeping regulatory changes on March 30 to address COVID-19 patient surge, Cleveland Clinic assembled a team of IT, coding and billing experts to help translate the new telehealth policies and waivers into clinician-friendly electronic workflows.

Artificial intelligence in medicine: Getting smarter one patient at a time

What if doctors had more time to spend addressing their patients' concerns? That's the thrust behind the push for integrating artificial intelligence (AI) into medicine. By using complex algorithms to detect patterns in large datasets—like lab test results, current medications, and symptoms, to name a few—AI might actually make medicine more personable—not less.

CMS: Value-Based Reimbursement Key to Addressing Health Disparities

Health disparities proven by Medicare claims data during the COVID-19 crisis underscore the need to transition to value-based reimbursement, according to CMS.

Secure Payment Processing to Protect Patient Privacy

HIPAA’s Privacy and Security Rules specify 18 data elements that an individual could use as a means to determine a patient’s identity. The majority of this vulnerable data are easily understood (e.g., name, address, phone number, etc.) and can be applied to nearly any business, however, there are some elements that relate specifically to the healthcare process, including a...

HHS Issues Requirements for Additional Data and Timely Submission of COVID-19 Testing

With concerns of COVID-19 having a disproportionate impact on certain individuals, such as minorities and the elderly, public health experts are requiring more detailed data, provided on a real-time basis – further supporting the reliability and integrity of data being central to healthcare.

COVID will become an Excuse for Future RAC and MAC Audits

Being nice can get you in trouble. But as David Glaser, Dr. Ronald Hirsch, and I have said over and over, being nice and putting patient care first should be the excuse during this COVID pandemic for future Recovery Audit Contractor (RAC) and Medicare Administrative Contractor (MAC) audits. We believe that when you err or if you err, err on the side of the patient.