Wiki Anti-Fraud Reviews

[Veteran90]

Curious if there are any other coders out there who are using their knowledge of coding guidelines to review for inappropriate / fraudulent coding practices?

I work in a position that requires me to apply my knowledge of coding / medical treatment to the fraud assessment of $billions in submitted medical bills and am looking to network with other coders out there who may be working in a similar situation.

Am I alone in the world?



Looking forward to some good dialogue on this topic.

- - Jeff, RN, CPC

 

[kevbshields]

Although the breadth of my duties do not entain billions of dollars, we (as an organization) are charged with reviewing for inappropriateness, which includes fraud, abuse and general coding errors.

I have worked in a previous post where payer program integrity was integral to my job duties.