Home Health & Hospice Week

Predictive modeling could target your claims. Get ready for more scrutiny of your claims before they are paid, thanks to the feds' new predictive modeling initiative. Background: A provision in last year's Small Business Lending Act required the Centers for Medicare & Medicaid Services to start using predictive modeling software to verify suspicious claims before paying them (see Eli's HCW, Vol. XIX, No. 36, p. 286). Under the Obama administration, CMS is implementing the predictive modeling effort ahead of schedule, says a release from the agency. CMS has tapped Northrop Grumman to develop and implement the software. The program goes nationwide as of July 1. How it will work: "Original Medicare claims will be analyzed using innovative risk scoring technology that applies effective predictive models," CMS explains in a release. Credit card companies use a similar approach to identify fraud. "For the first time, CMS will have the ability to [...]