Data Analysis

7.2.2.14 - Data Analysis (Rev. 444, Issued: 12-14-12, Effective: 04- 01- 13 (FISS and MCS); 07-01-13 (VMS); Implementation: April 1, 2013 (Implementation of FISS and MCS); July 1, 2013 (Implementation of VMS) Used to identify and verify potential errors to produce the greatest protection for the Medicare program. Data analysis is an essential first step in determining whether patterns of claims submission and payment indicate potential problems. It includes simple identification of aberrancies in billing patterns within a homogeneous group, or much more sophisticated detection of patterns within claims or groups of claims that might suggest improper billing or payment. Data analysis is undertaken as a part of general surveillance and review of submitted claims, conducted in response to information about specific problems stemming from complaints, provider or beneficiary input, fraud alerts, reports from CMS, other ACs, MACs, or independent government and nongovernmental agencies. Background The Contractor uses CERT findings, internal and external data sources, review of claims, and information from other operational areas to identify patterns of erroneous billing submissions and areas of over utilization to target provider-specific review.