Beginning July 1, the Centers for Medicare & Medicaid Services (CMS) will begin using new predictive modeling tools to root out fraudulent Medicare claims. CMS says its approach is based on using real-time data to indentify fraud as credit card companies do. Last year’s Small Business Jobs Act of 2010 provided funding - $100 million - for CMS to implement this technology.
The agency contracted with Northrop Grumman to develop processes to review claims by beneficiary, provider, service origin or other patterns and identify potential problems. Claims that raise concerns will be flagged and assigned a “risk score,” which will determine the agency’s next steps before it pays the claim. While CMS originally planned to roll out the program gradually, it announced last week that it will go nationwide on July 1. MGMA will work with the agency to ensure that this new technology does not interfere with timely payment of legitimate claims. To date, the government has not provided further details on this program. MGMA will alert members to additional information as it becomes available.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at
http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
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