BC Advantage - 2013 Issue 2

Comparative Analytics: The Only Answer to Stay Ahead of RAC and Other Audits

By Michael L. SandersonThe government's continued implementation of health care reform has resulted in a nationwide crackdown on Medicare fraud, making it a key priority for auditors to analyze comparative billing data to spot physician outliers among their peer groups.In a September 24 letter to the CEOs of the nation's top hospital associations, academic health centers, and medical colleges, the Secretary of Health & Human Services and the U.S. Attorney General made it known that the Centers for Medicare and Medicaid Services (CMS) is specifically reviewing comparative billing data through audits to identify and prevent fraud and...

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