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.

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. – 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.