While the cause of the rise in asthma and allergy rates over the past several years isn’t 100 percent clear, one of the effects is certain: a notable increase in billing and payment of allergy and asthma codes. And some providers are exploiting the high reimbursement rates and limited oversight associated with these codes, obtaining payment for services that may not be medically necessary or provided at all.
Fortunately, when reviewing claims for allergy testing, there are several fairly simple key indicators to look for, such as:
Are the positive and negative controls included in the number of tests reported?
Is the provider testing allergens the patient won’t come into contact with on a regular basis?
Are food allergens being tested with no reported gastroenterological symptoms?
Is the provider billing for the same tests or number of tests across several patients?
Detecting more complex billing patterns of possible fraud, waste, and abuse requires the use of advanced analytics.
I hope you can join me for Verscend’s on-demand webinar, where senior functional analyst Erynn Lesondak and I offer investigators' perspectives on how to recognize red flags in asthma and allergy medical record documentation that would warrant a more in-depth medical review.
We’ll dive deep into how you can:
Identify top paid allergy and asthma codes used in common healthcare schemes
Analyze asthma and allergy claims data effectively to identify patterns and schemes
Recognize red flags when conducting cursory examinations of medical documentation
Don’t let asthma and allergy schemes hurt your bottom line—watch our webinar on-demand and learn how to spot and prevent them.
Sharron Cannella is a supervisor with Verscend’s Program Integrity Services team, where she is responsible for managing fraud investigations for a variety of healthcare payer customers. Prior to joining Verscend, she worked for a private insurance carrier and with a Zone Program Integrity Contractor under the Centers for Medicare & Medicaid Services. She was also a Federal Bureau of Investigation special agent for nine years, serving on the Los Angeles Healthcare Fraud Strike Force investigating various healthcare fraud schemes, including home health agencies, durable medical equipment suppliers, mental health centers, and specialty providers. Sharron is also a recipient of the United States Attorney’s Office Award for Excellence in a Healthcare Fraud Investigation and has 16 years of law enforcement experience.