Industry Note:
Data Mining-Triggered Edits On Deck
Published on Thu Nov 29, 2012
If your billing patterns make you stick out like a sore thumb, you may see pre-payment consequences sooner than you think. The Centers for Medicare & Medicaid Services is aiming to integrate its new data-driven Fraud Prevention System with its payment processing system by January, says the Government Ac-countability Office in a new report. "FPS analyzes Medicare claims data using models of fraudulent behavior, which results in automatic alerts on specific claims and providers, which are then prioritized for program integrity analysts to review and investigate as appropriate," GAO explains. However: CMS has "not yet developed reliable schedules for completing this activity," the GAO says of the FPS-payment system integration. The report is at
www.gao.gov/products/GAO-13-104.
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