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...
Karen Weintraub, EVP at Healthcare Fraud Shield, will present “Unmasking Phantom Providers: Leveraging Link Analysis, Analytics and External Data” as part of the 2026 Schemes for Health Care Fraud Investigators and Analysts virtual program. Originally featured at the...
Fraud is evolving faster than traditional controls. Schemes are more coordinated and documentation is more engineered. Billing patterns are designed to survive first-pass reviews. And many organizations are still reacting after payment. If you lead SIU, compliance,...
Applied Behavior Analysis (ABA) is commonly used to treat individuals with Autism Spectrum Disorder (ASD). Treatment is designed to improve communication, social skills, and adaptive learning. However, as the prevalence of ASD diagnoses has risen, so has the risk for...
