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Healthcare Fraud Shield's Fully Integrated Suite of Products & Services
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QueryShield™
To see an overview of Healthcare Fraud Shield Products and Services click
HERE
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Product Highlight-
360ProReport™
360ProReport™ is an innovative product that fuses thousands of data sources seamlessly together to deliver the most current and accurate view of a provider in a single report. The data sources are a combination of critical industry databases, government databases, media articles, public records and proprietary information. A customer can also easily add in their own unique data sources to add customized value to the intelligence.
360ProReport™ also provides the unique ability for a customer to have the choice of
- Ordering a comprehensive Public Record report
- Provider Licenses
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- National Provider Identifier (NPI) History
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- SSN Death Master
- Excluded Individuals and Entities
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Coding Corner
Send a coding question to our coding experts to
[email protected]. If your question is selected, you will be eligible for a prize and we'll publish the question along with the answer in one of our weekly articles.
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Welcome to Healthcare Fraud Shield's newsletter. This
week we exam "Get Up to Speed with Rapid Desensitization.
"
Check out the article below or on the
Healthcare Fraud Shield blog
where you can access all of our previous articles.
Sincerely,
Healthcare Fraud Shield
Join us for Healthcare Fraud Shield's NEXT COMPLIMENTARY WEBINAR titled
"
Unlocking Secrets of Physical Medicine Coding
" on Tuesday,
June 28, 2016 at 2:00 pm EST. Click HERE to register and for information regarding eligibility.
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Get Up to Speed with Rapid Desensitization
Rapid desensitization or rush/cluster immunotherapy is the process of quickly establishing a patient's tolerance to an allergen through a series of injections over a few hours. A maintenance dose can be reached in as short as 1 to 8 days. All immunotherapy should be done in a doctor's office or clinic so that emergency care is available
[i]
.
This therapy should only be performed by a board certified allergist or provider with additional training or certification in rush immunotherapy. Most payers have medical policies addressing the medical necessity of this treatment. For instance, according to Blue Cross Blue Shield of North Carolina's medical policy the following criteria must be met:
- The patient has an allergy to a particular drug that cannot be treated effectively with alternative medications. [Although not considered allergy immunotherapy, drug desensitization is considered medically necessary when there is no alternative medication or therapy available to treat a life-threatening condition. Desensitization is an immunologic method that allows allergic patients to receive the sensitizing drug safely. Drug desensitization involves the rapid administration of incremental doses of a specific drug for patients with IgE antibodies to the drug that cannot be treated effectively with alternative medications. Drug desensitization is covered only when no alternative drug is available for therapy and the risk of continued administration of the offending drug may be less than the risk to life posed by the underlying disease.]; OR
- Insect sting (e.g., wasps, hornets, bees, fire ants) hypersensitivity (hymenoptera); OR
- Moderate to severe allergic rhinitis requiring treatment during or immediately before the
season of the affecting allergy[ii].
Rapid desensitization is reported with CPT 95180- Rapid desensitization procedure, each hour (e.g., insulin, penicillin, equine serum).
Based on this information, the investigator should look for the following red flags in their data to detect inappropriate rapid desensitization procedures:
- Non-allergy providers billing CPT 95180 as they may not be qualified/experienced in this procedure
- Excessive units of 95180 reported. As stated in the code definition, the units for this code are reported in hours. Typically providers would bill about 3 hours/patient on one date of service. Watch for providers who may be reporting this procedure in minutes, i.e. units reported as 120, 180, etc.
- Providers who frequently bill 95180 when compared to the standard allergy immunotherapy injections (95115, 95117, etc.). Remember, this should not be the first line of treatment for every allergy patient!
If you have questions or are interested in learning more about Healthcare Fraud Shield's FWA analytics, feel free to email us at
[email protected].
Join us for Healthcare Fraud Shield's NEXT COMPLIMENTARY WEBINAR titled "Unlocking Secrets of Physical Medicine Coding" on Tuesday, June 28, 2016 at 2:00 pm EST. Click
HERE
to register and for information regarding eligibility.
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About Healthcare Fraud Shield
Healthcare Fraud Shield is based in Chesterfield, Missouri and provides advanced FWA (Fraud, Waste and Abuse) detection systems to the healthcare industry. The company's services enable investigators to quickly identify suspicious activity and accurately pinpoint fraud. Our unique technology allows our customers to maximize loss prevention and recovery efforts with a substantial ROI.
16052 Swingley Ridge Road, Suite 200,
Chesterfield, Missouri 63017
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