OMB Individually Reported
Artificial Intelligence Use Case Pilot in Medical Review on Medicare Fee-For-Service (FFS) Improper Payment Measurement (Comprehensive Error Rate Testing Program) Data
Low riskExact public inventory row
Description
OFM is hoping to leverage cutting-edge AI technology to potentially introduce new efficiencies and accuracy in the Comprehensive Error Rate Testing (CERT) medical review process by moving away from manual medical review which is costly, sometimes inaccurate, and inefficient.
Detailed example
Recommendation
AI / analytics pattern
Generative AI: AI that generates new or synthetic content (e.g., images, videos, audio, text, code).
Automation level / stage
a) Pre-deployment – The use case is in a development or acquisition status.
Expected benefit
Expected benefits include cost savings, new efficiencies and accuracy of clinical medical review decision making for reporting meaning Medicare FFS improper payment improper payments.
Controls / human review
ATO: Not reported; PIA: Not published