What stands out most to me about the Predictive Modeling Analysis of Medicare Claims is that the predictive analytics system uses algorithms and models to examine Medicare claims in real time to flag suspicious billing.
Real time claims streaming to build profiles and create risk scores and CMS is streaming all Medicare claims through its predictive modeling technology. As each claim streams through the predictive modeling system, the system builds a profile of the providers, networks, billing patterns, and beneficiary utilization. The profiles let CMS create risk scores that will estimate the likelihood of fraud as well as flag potentially fraudulent claims and billing patterns. Risk scores enable CMS to quickly identify unusual billing
Real time claims streaming to build profiles and create risk scores and CMS is streaming all Medicare claims through its predictive modeling technology. As each claim streams through the predictive modeling system, the system builds a profile of the providers, networks, billing patterns, and beneficiary utilization. The profiles let CMS create risk scores that will estimate the likelihood of fraud as well as flag potentially fraudulent claims and billing patterns. Risk scores enable CMS to quickly identify unusual billing