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The IQ: Our Brain Boosting Blog

Use of CPT Codes to Analyze Physician Occupation

10/8/2025

1 Comment

 
​Should CPT codes be used for billing or occupation analysis? The answer is both. 
 
In a recent lawsuit, an argument was raised that Current Procedural Terminology (CPT) codes were created and are used for billing purposes, so they should not be used in determining occupation for some reason.  One of the arguments made by an expert in the case was that charges were used, which is not a realistic measurement, as reimbursements and payments received are always less than the charge amount.  The counter argument is that charges are only one metric we use, and we recommend and use Relative Value Units (RVU) and units in all CPT analyzes.     
 
This blog will show why they can be used for both billing and the verification of a physician’s occupation.  

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Understanding and Combating Fraud, Waste and Abuse in Life, Health, and Disability Insurance Claims

9/4/2025

1 Comment

 
​Insurance fraud, waste and abuse (FWA) pose significant challenges to the integrity and financial stability of the insurance industry. These activities inflate costs, undermine trust, and divert resources away from legitimate claimants, ultimately impacting consumers, insurers and the economy. Combatting FWA requires a comprehensive understanding of its forms, particularly within vital areas such as life, health and disability insurance. This article explores these issues, providing detailed definitions, illustrative examples and real-world case studies to elucidate the nature of FWA and strategies to mitigate it.

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Did You Know

8/13/2025

1 Comment

 
Policies may be voided after the contestable period has expired.  There is a common myth that once a policy’s contestable period has expired, there is nothing an insurance company can do to void the policy if fraud is found.  While it is certainly true that the threshold of proof required to void a policy outside the contestable period is higher than rescinding a policy for material misrepresentation, the expiration of the contestable period does not bar action against fraudulent activity.

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Fraud crimes besetting the life and health insurance industry

8/6/2025

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Synthetic persons, forged documents, bribery, murder, wire fraud and identity takeovers are just some of the fraud crimes besetting the life and health insurance industry.​

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What You Don’t Know About VA Disability Can Hurt You

8/6/2025

0 Comments

 
​If you want to test your knowledge about VA compensation, ask yourself this question: What does the acronym “VA” mean.
 
If you said Veterans Administration, you are wrong. “VA” refers the Department of Veterans Affairs. This is a tell-tale way to know whether the person you are talking to is knowledgeable on the subject. If they refer to the VA as the Veterans Administration, then I would suggest taking their comments with a grain of salt.

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Why It Is Crucial to Keep Your Own Beneficiary Designations Up to Date.

8/4/2025

0 Comments

 
​As professionals working in the insurance industry, we have seen firsthand how outdated or unclear beneficiary designations can create unnecessary delays in claim processing, disputes, legal costs, and hardship for families during an already difficult time. 

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A Guide to Understanding Annuity Settlement Options at Claim Time

7/15/2025

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When the owner of a tax-deferred annuity passes away, there are several settlement options available to a beneficiary. In this short blog, we’ll go over the basics and explore the most common annuity settlement options.

What is an Annuity?
Interestingly, the concept of annuities goes back in time between AD211 and AD222.  European monasteries raised funds by selling life annuity products and used acclaimed mathematicians from their scientific communities to support the refinements of pricing models.  

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Group Healthcare Fraud: A $1.2 billion case and industry solutions

5/21/2025

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A recent healthcare fraud case highlights the need for insurers, healthcare providers, and policymakers to work together to protect healthcare resources, reduce fraud-related financial losses, and ensure patient care remains the top priority.
​

Key takeaways
  • A $1.2 billion healthcare fraud case underscores the critical need for enhanced oversight and robust preventive measures within the healthcare industry.
  • Solutions include advanced data analytics, improved training, collaboration with law enforcement, and regular audits and compliance checks.
  • RGA invites you to join us virtually for the 13th Annual RGA Fraud Conference August 12-14, 2025.

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The New Driving Force of Employee Experience During Time Away from Work

4/8/2025

4 Comments

 
​In the evolving landscape of workplace absences, disability claims have long been a cornerstone of employer policies. However, as leave programs such as the Family and Medical Leave Act (FMLA), state-level unpaid job protection, and more recently Paid Family and Medical Leave (PFML) initiatives have expanded in scope and visibility, it is increasingly becoming these policies that are shaping the employee experience. While traditionally an employer’s disability policy was the key component of an employee’s time away from work, disability programs have become somewhat commoditized and are now viewed more as a starting point. Instead, leave programs that support a broader range of leave types and often provide richer benefits have become central to how employees perceive their workplace support during critical life events.

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The Future of Insurance Claims: Balancing AI and Human Connection

4/4/2025

5 Comments

 
Do you remember the movie The Imitation Game? It’s a 2014 film where Benedict Cumberbatch plays Alan Turing, the brilliant mathematician whose work on breaking the Enigma code helped end World War II. What stuck out was Turing’s central question: Can machines think like humans? ​

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  • Membership
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