Category: Coding

ADVANCEMENTS IN A.I. ARE COMBATING HEALTHCARE FRAUD

Advancements in A.I. are Combating Healthcare Fraud

The National Health Care Anti-Fraud Association estimated that healthcare fraud costs the nation $68 billion annually. (BCBS, n.d.) An article on the Physicians Practice website published February 18, 2021, stated, “In January 2020, the U.S. Justice Department reported that over $2.6 billion had been recovered from lawsuits relating to medical fraud.

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Medical records on a shelf

2021 E/M Guidelines Take Effect

Since the initial evaluation and management (E/M) guidelines were released in 1995, and again in 1997, there has been controversy. The American Medical Association and the Centers for Medicare and Medicaid Services have joined together to arrive at a consensus that will reshape evaluation and management (E/M) guidelines. The changes in evaluation and management guidelines for 2021 only apply to office or outpatient codes 99202 – 99215.

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