2023 Forensic AI Alerts Roundup and eBook

This valuable resource is a must-read for healthcare organizations seeking to mitigate fraud, waste, and abuse and maximize cost savings

Healthcare executives face the daunting task of finding ways to control and manage the alarming cost increases. When priority setting, a key focus area for leaders should be fighting fraud, waste, and abuse (FWA), which accounts for as much as 10% of the $3.8 trillion spent on healthcare each year. Just as important is ensuring that cost-containment teams are continually educated about healthcare industry trends that impact billing processes.

Trending Fraud Schemes & Coding Errors. One Valuable eBook.

At Codoxo, our mission is to make healthcare more affordable and effective. We work to achieve this by constantly evolving our award-winning artificial intelligence (AI) tools to detect and prevent FWA and improve payment integrity. Each month, Codoxo’s FWA and payment integrity domain experts publish Forensic AI Alerts, which provide cost containment teams with timely news about trending FWA schemes, Current Procedural Terminology (CPT) coding changes and updates, and new or evolving treatments that can impact billing and healthcare payer bottom lines.

Knowledge is power. That’s why we invest in sharing our expert insights continuously to help cost containment teams fight FWA and improve payment integrity. Get excited – because our monthly Forensic AI Alerts throughout 2023 are now available in a comprehensive eBook:

Download Now: The Forensic AI Alerts eBook: 2023 Fraud, Waste, & Abuse Trends to Guide 2024 Healthcare Cost Containment Plans

When leveraged in combination with our sophisticated healthcare AI technology, healthcare organizations can more effectively identify hidden cases of fraud, waste, or abuse and uncover dramatic new savings opportunities.

Sample Schemes Included in the 2023 Forensic AI Alert eBook 

Monitoring trends throughout the year, we often see recurring themes making headlines. These trends guide the editorial focus for our Forensic AI Alerts.

Misuse of Weight Loss Prescription Drugs
In 2023, one major media headline was the use, misuse and shortages of weight loss prescription drugs. As such, multiple Forensic AI Alerts detailed schemes related to prescription fraud with brand name drugs such as Ozempic and Wegovy. We also explored the dangers of off-brand drugs and supplements being sold as lower cost alternatives to the more expensive, harder to get name-brand drugs. To assist with claims processing, our monthly alerts provided a list of FDA-approved weight-loss drugs (both generic and brand names), as well as specific diagnosis codes related to obesity and diabetes, which are often linked to the brand-name drugs.

Audio-Only Telemedicine Code Modifier
Last year, the rise in telehealth also continued, including both audio-only services and evaluation and management (E&M) services. Our Forensic AI Alerts offered insight into correct use of the audio-only telemedicine code, modifier 93, and flagged suspicious billing practices for cost containment teams. Because we noticed an increase in the utilization of telephone E&M services for medical appointments, we shared specific criteria to look for when billing departments are evaluating claims for accuracy. We also spotted increased utilization by psychiatrists performing psychotherapy services and billing a high level of E&M service on the same date. This spurred our team to investigate claims data for those peer groups, so as to identify outlier trends and behaviors and to offer recommendations of what to look for when reporting with both types of services for the same patient, the same day.

Additional Schemes Covered
Codoxo’s Forensic AI Alerts covered a variety of other timely topics as well – such as the increase in chemotherapy injections being used to treat asthma, colonoscopy billing guidelines, an explanation of and tips for Risk Evaluation and Mitigation Strategy (REMS) billing, dental fraud, and more. Our alerts often go a step further to suggest ways to utilize Codoxo’s AI offerings to identify and manage outlier behavior efficiently and effectively.

Download Now: The Forensic AI Alerts eBook: 2023 Fraud, Waste, & Abuse Trends to Guide 2024 Healthcare Cost Containment Plans

Codoxo is committed to the advancement of innovative AI solutions that proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. We will continue to monitor industry trends to provide cost containment teams and healthcare executives with timely, actionable recommendations across a variety of specialties.

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Are you interested in learning how Codoxo’s patented AI technology uses the most effective AI to ensure payment integrity and anticipate and find fraud, waste and abuse and ensure payment integrity? To speak with a Codoxo team member, contact us at info@codoxo.com.