When Special Investigation Units (SIUs) and Payment Integrity (PI) teams think of durable medical equipment (DME) fraud, classic schemes often come to mind: unnecessary brace shipments and telemarketing lead-generation mills. But as analytical defenses grow sharper,...
Telehealth billing remains complex as payer requirements continue to vary across procedure codes, modifiers, and places of service. Medicare, Medicaid, and commercial plans may apply different billing expectations, creating risk when providers use a uniform approach...
Risk adjustment involves billing diagnosis information that is properly supported in the medical record. It estimates the expected annual cost of care and aligns payments to the complexity of a patient’s conditions. Because payments rise with diagnosis severity, an...
When it comes to healing, sometimes our skin needs a little more than a kiss it and make it better approach. Complex, non-healing, or chronic wounds require clinical interventions to jump start the body’s natural healing process. These specialized procedures are...
Healthcare Fraud Shield will be attending the Medical Cost Containment Series to engage with payer leaders focused on cost control and payment accuracy. Meet with our team to discuss how AI-driven insights and flexible, integrated solutions help reduce improper...
