Frank Cohen, Director of Analytics, Doctors Management LLC.
April 8, 2019
The CMS, along with private payers, are using advanced statistics and predictive modeling to identify providers that are considered potential billing and coding abusers. These providers are then targeted for complex chart audits
One of the tools used is the Fraud Prevention System (FPS), which relies upon predictive models for risk identification. Short of that, auditors (and the media) use the Public Use Files to point out physicians they think are abusing Medicare dollars
In this session, attendees will learn about how the FPS works and how to interpret the Public Use Files to get an a priori look at Medicare risk for their providers. If you want to know what the auditors know, this is the session for you
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