Researchers at RTI International are seeking comments regarding model standards they have developed to prevent medical claims errors and detect health care fraud that will be recommended for use in electronic health record systems (EHRs). The six-month project was awarded to RTI by the Office of the National Coordinator for Health Information Technology.
These model claims efficiency standards will aim to improve claims accuracy and to reduce the ability for individuals to create fraudulent claims and other improper payments against public and private health care plans.
Those interested in reviewing and commenting on the recommendations must register at http://ehrantifrauddev.rti.org. The review process will be completed at the end of January.
"The move to EHR systems represents a unique opportunity for improving billing accuracy and reducing health care fraud and improper payments, however the model standards developed must be critiqued by the larger community in order to be meaningful and useful to those who will use the systems,” said Colleen McCue, PhD, a senior research scientist at RTI and project manager. "Everyone who would like to comment has the opportunity.”
The executive team charged with delivering the final model requirements will revise the draft anti-fraud requirements based on the public feedback they receive.
"Currently, most billing errors or fraud is detected after payment is made, which makes dealing with the claims very inefficient for both the provider and the payer,” McCue said. "EHR systems will allow for the opportunity to correctly bill from the very beginning, which will help physicians to receive accurate payments and ultimately, will reduce fraud.”