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As a coder, you are at the front lines when it comes to the origins of a medical claim. This session will focus on red flags to be aware of when coding a claim, and what to watch for prior to that claim being sent to the insurance company. The reality is that healthcare claims are reviewed and analyzed for suspected fraud, waste and abuse. To help from a coding perspective, this session will focus on defining fraud, waste, and abuse, and how you can prepare for an independent audit. We will also discuss the perspective of an insurance company and what tools they use to benchmark and analyze claims data, and what steps your organization can take to understand your own internal benchmarks.

Why is this topic important?
Coders play a key role in fraud prevention because they are on the frontlines and origin of a claim/medical bill. This topic helps coders know what to look for and steps to take to prevent fraud, waste, and abuse (FWA).

Who would benefit from this topic?
Coders, Auditors, Compliance Officers, Coders that work for payers.

How would this benefit the individual and/or their company?
The individual will learn what FWA red flags to look for, and can be proactive within their organization on what they are seeing, and questioning if something doesn’t look right. The organization benefits by providing training to their staff, and knowing they have certified coders that know how to accurately code.

What information or new skills will the attendee take away from this webinar?

What are the FWA red flags to be aware of

What steps you can take as a coder or auditor

What can you do to better understand your organizations patterns

What is the perspective of the health plan/payer

What tools does a health plan use to benchmark and analyze claims

About The Presenter
Jeff has been in the health care industry for over 20 years, more than half of that time has been spent preventing and detecting fraud, through analyzing claims data, building applications to detect fraud, and managing investigative staff. Since joining AAPC/Healthicity four years ago, he has continued to focus on providing tools in the areas of compliance and auditing.

Agenda

• Introduction
• What is Healthcare Fraud
• How can I prevent fraud as a coder?
• Perspective of Health Plan

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