Fraud, waste, and abuse (FWA) in the healthcare industry is a multi-billion-dollar problem, accounting for as much as 10% of the $3.8 trillion spent on healthcare each year. While healthcare executives are motivated to address the pressing problem, the ever-shifting healthcare landscape and the need to keep up with coding updates, compliance mandates, and emerging fraud schemes makes it difficult to keep pace.
To provide cost containment teams a trusted source for tracking industry updates, each month Codoxo’s payment integrity and FWA domain experts publish a Forensic AI Alert – a valuable and timely summary of new FWA schemes, the latest coding guidelines for viruses, helpful research for educating our clients how to make data-informed decisions, along with recommendations to save money and increase ROI.
These monthly insights are now available as a single new resource: the Forensic AI Alerts eBook: 2022 FWA Trends to Inform 2023 Cost Containment Strategies. Can’t wait to read it? Download now.
Here’s an overview of some of the major eBook highlights and how to make the best use of this new resource.
Identified FWA Risks and Real-Time Recommendations
Throughout 2022, the Codoxo Forensic AI Alerts covered areas such as COVID-19, telehealth, and physical therapy emerging trends. Additionally, Codoxo’s research team highlighted threats to categories including optometry and the dental industry while providing important coding updates to address testing and treatment of the Monkeypox and RSV viruses. We shared new information about billing codes related to these conditions and advised billing teams to be aware of discrepancies related to FWA.
In July, Codoxo focused on the latest FWA risks affecting the dental industry. With an estimated $12.5 billion (or 5%) lost each year to dental FWA, healthcare companies need to thoroughly understand what to watch for as they process and review customer claims. We provided upcoding trends and services to be aware of and specific dental codes that may indicate the presence of fraud.
Our experts also observed an optometry procedure, CPT code 65778, for treating dry eye disease that required close monitoring. The October AI Alert pointed out specific areas where FWA could occur, and included step-by-step instructions for utilizing Codoxo’s AI offerings to identify coding errors and violations.
In December, as the United States continued to battle RSV – which arrived in the country earlier and more aggressively than usual – our AI Alert provided time-sensitive guidance related to prescribing and processing claims for the RSV treatment, Synagis.
Re-envisioning Healthcare Affordability
While 2022 was a challenging year for healthcare fraud, waste, and abuse, Codoxo is committed to educating healthcare payers, PBMs and agencies with the most accurate information, trends, and FWA threats that could impact their bottom line. Our monthly Forensic AI Alerts and eBook roundup reflect how Codoxo continues to promote its mission of making healthcare more affordable and effective for everyone.
“Cost containment is a key priority for our clients, and to have the best possible outcome it’s imperative to understand the latest healthcare trends and pitfalls that may lead to fraud, waste and abuse,” said Rena Bielinski, Codoxo VP of Customer Success. “Our Forensic AI Alerts provide time-sensitive updates and actionable recommendations to help our customers be prepared as the industry continues to evolve.”
Download the Forensic AI Alerts eBook: 2022 FWA Trends to Inform 2023 Cost Containment Strategies now.
You can also explore the entire year of topics in this convenient collection of Codoxo Forensic AI Alerts:
- Identifying outlier utilization of Synagis during the RSV season
- A Sharper View of Evolving Optometry Specialty Emerging Schemes
- Double-down on Single Diagnosis Care Management Codes
- Monkeypox Declared a Public Health Emergency – Coding Guidelines and Health Plan Preparation
- Dental Fraud, Waste and Abuse: A Billion(s) Dollar Problem
- Pharmacy Audit: Educating Your Pharmacy Network
- Telehealth Place of Service Coding Changes
- ICD-10-CM Coding Update: Post Covid Conditions
- Covid-19 Updates
- Let’s Talk Physical Therapy Emerging Trends
- Diving into Hyperbaric Oxygen Therapy
- Know Your Mohs, Part II
- Know Your Mohs, Part I
In looking ahead to 2023 and beyond, Codoxo will remain on the front lines – ensuring that healthcare leaders and providers have the information and resources they need to quickly detect bad actors and make necessary interventions that save money and time in the fight against fraud.
Interested in learning more about how Codoxo leverages the latest artificial intelligence, machine learning, and automation to address FWA and promote cost containment across the healthcare industry? To speak to a Codoxo team member about how we’re using AI to re-envision healthcare affordability and effectiveness, please contact us at email@example.com.