1. www.medicalbillersandcoders.com
New analytics model for future Fraud and abuse system
The Center for Medicare and Medicaid services is poised to take bigger steps in preventing
fraud and abuse by increasing its monitoring and analytics capabilities. CMS will conduct
enrollment and medical claims analytics to keep frauds out of Medicare, for this some
necessary technology is already deployed, while the other systems will be ready by the
coming year.
Browse all: physician billing
CMS is using the latest technologies for a fraud prevention system to scrutinize Medicare
claims. The prepayment review will be used as an investigative technique to follow leads
and determine if there is any pattern of a problem. In the past, CMS had access only to
post-payment claims information.
CMS will also conduct analyses of providers who enroll in its programs, assign risk levels to
them and make its enrollment system more automated to accommodate new data, such as
Social Security death files and loss of licensure. The automated provider enrollment
screening, which will replace the more manual system, will be operational in January.
The scenario warrants providers to either build or outsource proven anti-fraudulent
measures that can ensure them to surpass them through these new investigative
techniques.
Medicalbillersandcoders.com – the largest medical billing consortium and advisory for many
insurance carriers has proven history of helping healthcare providers to understand and
curb errors and fraudulent practices. With exposure in billing and coding across specialties
and payers, and expertise in all billing issues related to the latest compliances and
regulations, the consultancy services of MBC can assist in scrutinizing unintentional billing
errors, and pro-actively minimize compliance exposure by healthcare providers.
Browse all: medical billing service, healthcare medical billing
Source: Medical Billing (http://www.medicalbillersandcodersblog.com/)
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