CMS to Use ICD-10 Codes to Spot Fraud Starting Oct. 1

Starting Oct. 1, the day ICD-10 goes into effect, CMS’ fraud prevention system will use data from the new code set to identify patterns that could indicate fraud, according to a Healthcare Finance News report.

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CMS will not be able to match ICD-9 patterns, so many legitimate claims could get flagged as being potentially fraudulent.

The biggest problems will come if the federal government refuses to pay claims and be repaid for those found fraudulent. Proper documentation will be necessary to show legitimacy.

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