CMS Shares Claims Data with Private
Payers
In a recent article posted in “Part B News” this past week,
future plans for a new partnership between CMS and commercial payers will share
medical claims data in an effort to detect overpayments, fraudulent billing and
procedure code abuses. This partnership includes CMS, the Justice Department,
Blue Cross and Blue Shield Association and 8 private payers.
What will this mean to providers? The good news is better
communication of data for secondary and tertiary Medicare supplemental payers
and secondary payers. The bad news for providers will be increased scrutiny of
all claims data in general and more likely increased audits. Recent audits from
both the Office of Inspector General (OIG) and the Medicare Recovery Audit
Contractors (RAC) have proven that there are a lot of funds to be collected due
to overpayments to providers.
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