CLIENT: Centers for Medicare and Medicaid (CMS)

PLACE OF PERFORMANCE: Baltimore, MD

PERIOD OF PERFORMANCE: 2019 - Present

TECHNOLOGIES USED:

SITUATION: For the Risk Adjustment Data Validations (RADV) Medical Record Review Contractor (MRRC B) Contract, the Centers for Medicare and Medicaid (CMS) were in need of an updated approach to assessing Fraud Waste and Abuse (FWA) in their medical records. Typically, this process had been done by hand and was highly cumbersome, time-consuming, and inefficient. They sought to develop and integrate an automated approach that would optimize this process, increase accuracy, and save time.

TASK: As a subcontractor to Visual Connections (VC), nDemand was tasked with providing project coordination, project management, and process improvement services to support VC’s mission of creating an automated system to detect FWA using Artificial Intelligence and Natural Language Processing (NLP).

APPROACH: We supported VC’s design of business intelligence reports, which used SAS to inform CMS of abstraction findings in near–real-time, by bringing in best practices around project management, scheduling, work breakdown structuring, administration, and creating process flows. nDemand supported the development of a security plan and data use agreement, gained access to critical systems including the CMS IDR, CMS Mainframe, and CDAT, while assisting CMS system oversight efforts.

RESULT: As a result of nDemand’s efforts, VC’s mission to provide an AI-guided automated system for reviewing medical records was an overwhelming success. CMS received a greatly improved method of ongoing medical record reviews, as well as supplemental data analysis to help identify improper payments in the Medicare Advantage Program. Our team provided policy and operations consultation support to the CMS/CPI Program Manager, demonstrating innovation, customer service, decision making, and strategic thinking competencies.