Is it a cold? Is it the flu? Or is it just your body’s way of saying, “Enough with the pumpkin spice, already?”
Whether we like it or not, cold and flu season is upon us! According to the Center for Disease Control and Prevention (CDC), an annual flu vaccine is the best way to reduce the risk of illness and serious complications from flu. For most people, September and October are ideal times to get vaccinated; however, vaccination should continue as long as flu viruses are circulating. CDC expects flu viruses to spread along with other viruses this fall and winter, including respiratory syncytial virus (RSV) and the virus that causes COVID-19, and recommends that people stay up to date on all vaccinations[1].
What to look for?
Potentially fraudulent billing of vaccines and/or treatments can occur in various ways. For example, you could start to notice unusual billing patterns, to include excessive claims and duplicate claims. Another area of concern is higher reimbursement rates (including spikes in reimbursements).
HCFS has you covered!
Data mining to find these patterns can be difficult. This could mean a higher exposure risk for potential overpayments. If you’re using the HCFSPlatform™, we have you covered. Our Artificial Intelligence (AI) models can help identify spikes in payments and other anomalous billing patterns. Additionally, we have over 100 Alerts set up regarding vaccine billing and these specific ones related to influenza:
[2478-01] – INAPPROPRIATE AGE, INFLUENZA VIRUS VACCINE, FLUBLOK
[2492-20] – OUTLIER, ADDITIONAL PAYMENT FOR COVID-19 IN-HOME VACCINATION
[2729-20] – UPCODING, INFECTIOUS DISEASE DETECTION, INFLUENZA A/B, CORONAVIRUS AND RSV
[5336-01] – INAPPROPRIATE AGE, FLUMIST FOR CHILDREN UNDER 2 YEARS OLD
[5336-02] – INAPPROPRIATE NUMBER OF SERVICES PER PATIENT, FLUMIST
Remember, while cold and flu season can be a drag, it’s also a reminder to slow down, rest, and take care of ourselves. So, grab a blanket, a good book, and your favorite comfort beverage. May your sneezes be gentle and your (health and overpayment) recoveries be swift.
References:
[1] https://www.cdc.gov/fluvaxview/coverage-by-season/2023-2024.html#:~:text=An%20annual%20flu%20vaccine%20is,to%2Ddate%20on%20all%20vaccinations
If you have questions or comments you may email us at [email protected].