Abstract
In July 2018, CMS requested assistance from Oak Ridge National Laboratory (ORNL) to provide expert data science support aimed at developing algorithms for data mining of medical data for operational and payment purposes. The project is intended to be exploratory: work is aimed at alleviating challenges associated with improper payments, specifically audit methodologies and targeting and changes to risk scores. Project goals include developing new, sophisticated methods for audit targeting and improved profile– payment error correlations, specifically focused on Medicare Part C, the program under which MAOs provide health care services to beneficiaries. ORNL conducted RADV analyses against RAPS and EDS data as well as a hospice landscape analysis per a January 2015 dataset that included Medicare beneficiaries who were in hospice in 2017 and 2018. Ongoing work under this project also involves development of predictive models for RADV investigations and hospice landscape.
Original language | English |
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Place of Publication | United States |
DOIs | |
State | Published - 2021 |
Keywords
- 97 MATHEMATICS AND COMPUTING