In 2011, CMS implemented a new technique for fraud prevention called the Fraud Prevention System (FPS) to identify fraud, waste and abuse in the current Medicare system. As a result, Medicare was able to prevent an estimated $115.4 million in payments during the first 2012 calendar year. Under the new system, Medicare identifies suspicious behavior, analyzes the information, and observes and prevents billing patterns or trends that are likely fraudulent rather than utilizing the old “Pay and Chase” methodology which usually identified fraudulent activities and attempted to collect for fraud after it occurred. With the implementation of this new methodology, practices need to identify any aberrant billing patterns that may identify their practice as potentially committing fraud and /or abuse.
Who should attend? All practices participating in the Medicare program, other governmental health insurance programs or third party carriers including all staff/personnel involved in the prevention of fraud and compliance programs for the practice.
- Thomas J. Force
Marsha S. Diamond - CPC, CPC-H, CCS Involved in the medical coding, compliance, billing, healthcare reimbursement, education and management fields for over 30 years in the Central Florida area encompassing academic medicine, hospital, hospital-based physicians, physicians and facility coding. Author of coding textbooks, Mastering Medical Coding, Code Compass, Understanding Hospital Coding and Billing, Coders Resource Handbook, as well as a significant number of coding and compliance-related articles for publications...
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