DecisionHealth, DecisionHealth - 2011 Issue 7 (July)

CMS has new way to target claims

Fraudulent claims will no longer be paid first and investigated later come July 1 when CMS launches its new predictive modeling initiative. CMS’s new tactic against fraud, a product of health reform, will be similar to technology used by credit card companies. Claims will be analyzed using risk scoring technology that will identify suspicious Medicare claims before they are paid.

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