“Employees and contractors at the Centers of Medicare and Medicaid Services spend countless hours every year reviewing thousands of medical records to ensure the accuracy of Medicare Advantage payments. An automated intake tool is working to change that.”
“Using emerging technologies such as robotic process automation, optical character recognition, machine learning and artificial intelligence, KPMG’s Intake Process Automation Tool ingests records as they are submitted and identifies potential problems according to set parameters, submission rules and coding guidance. Specifically, RPA orchestrates the steps of the intake process, OCR digitizes the scanned document and then AI and machine learning are applied to understand the document and extract the information necessary to validate the information.”
“Intake PA stands to save CMS time and money, said Payam Mousavi, KPMG’s lead director for intelligent automation for governments and the technical lead for the CMS project. The tool processes a record in about a minute, whereas human reviewers average about 65 minutes per record. The agency received 40,000 records in 2018 and expects to get 50,000 this year…”
“Much of the tool is new technology that CMS did not have, Mousavi said. His team saw the highly manual, repetitive process as a good use case for RPA, but RPA is not ideal for unstructured data or making decisions, he added. That’s where AI and the KPMG Ignite AI platform come in. It has natural language processing and machine learning algorithms to help understand the unstructured data in the documents.”
“Besides time savings, Mousavi sees two other benefits to the tool…” Read the full article here.
Source: RPA, AI help speed review of Medicare claims – By Stephanie Kanowitz, July 1, 2019. GCN.
