CMS Looks to Emerging Tech for Program Operations

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The Centers for Medicare and Medicaid Services (CMS) are looking to improve program administration with the usage of data analytics, automated technologies, and other emerging technologies, according to a request for information released on October 21. The RFI is open until November 20.

The RFI lays out five areas that CMS is looking to improve, and the issues that its current legacy systems cause. The main issues identified are:

  • AI Medical Record Review Tools in Medicare;
  • Documentation Requirement Repositories;
  • Advanced Technologies for Medicare Advantage;
  • Provider Enrollment, and;
  • Data Analytics and Data Systems.

“We must look to the best that the private sector, the provider community, and other external stakeholders have to offer in all of these critical areas – whether innovative strategies or new and advanced tools and technologies – and incorporate them into our programs, including Medicaid, wherever possible. Our goal is to bring cutting-edge innovation to all of the areas addressed here and beyond,” the RFI states.

The RFI notes that it is looking for recommendations as well as solutions, and is focused on reacting in real-time rather than chasing improper payment cases after the fact. CMS highlights several successful past technology implementations, including automated medical reviews, which CMS estimated to save $3.1 billion.

“We want to leverage existing private sector tools and technologies to allow legacy systems that contain current or historic data to work together seamlessly and quickly identify and address program integrity needs and opportunities,” the agency noted.

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