Identifying ABPS (Aberrant Billing Patterns) for Fraud Prevention at Physician Level

Event Information
Product Format
Prerecorded Event
Marsha S. Diamond, CPC, CPC-H, CCS
60 Minutes
Product Description

Ensure Effective Implementation of ABPS Identification Process with Handy Tips

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.

Session highlights:

  • What are Aberrant Billing Patterns (ABPS)?
  • What is the significance of ABPS?
  • How does Fraud Prevention System (FPS) actions promote savings?
  • Increased efforts of FPS, what are these increased efforts?
  • Example of FPS strategy
  • How and who utilizes ABPS information?
  • What are the results of these efforts?
  • What is the success of these additional efforts?
  • Proactive steps that a practice can take to resolve ABPS
  • Methods of identifying ABPS
  • Service analysis and productivity reports
  • Bell Curve calculations
  • Encounter forms/charge tickets
  • All you wanted to know about remittance Vouchers/Denials/Appeals
  • How to effectively utilize all you know?
  • Implementing an ABPS prevention program
  • What are the consequences from ABPS?
  • And much more...

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.

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About Our Speaker

Marsha S. Diamond - Emergency Department (ED) Coding Expert

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...   More Info
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