Notice ID: SSN210993
CMS seeks to identify and solicit feedback from capable sources regarding leading cutting-edge technology capabilities for machine learning and natural language processing software for Medicare FFS health care claims and medical records. At this time, CMS is only interested in procuring new application(s) that could be used by CMS and/or its contractors to identify improperly billed claims through non-human review of the medical record. The software shall be able to identify improper payments based on CMS’ coverage and documentation requirements and identify coding and medical necessity errors.
CMS is seeking software for Medicare FFS’s medical review programs that includes the creation of a dashboard available to CMS with real time statistics.
As part of our initial effort to identify new technology to enhance medical review capabilities, CMS issued two Requests for Information on October 21, 2019:
- the Request for Information on the Future of Program Integrity, and
- the Request for Information on Using Advanced Technology in Program Integrity.
The Requests for Information (RFIs) focused on obtaining input from stakeholders and experts on innovative methods and tools to elevate CMS’ program integrity efforts and on how the agency can better use emerging technologies, such as AI and machine learning, to ensure proper claims payment, reduce provider burden, and overall, conduct program integrity in a more efficient manner. The RFIs accounted for several areas, such as, Electronic Health Records and Finding Documentation Requirements, Data Analytics and Data Systems, Medicare Claim Review, and Education.[1] Each of these influence our medical review efforts.
Looking forward, CMS is seeking new, innovative solutions and technologies, such as artificial intelligence tools such as machine learning and/or natural language processing, which may be more cost effective to the Medicare FFS program.
