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Medicare Claims and Records Review: CMS Teams Up with Artificial Intelligence (AI)

Updated: Sep 5, 2023

In the very near future, your current documentation practices may leave you vulnerable to prepayment reviews, claim denials, and post-payment audits.

Most doctors already question whether they are documenting properly or completely enough to support medical necessity and codes billed. CMS is going high tech and officially upping the ante 2020.

The implementation of artificial intelligence will soon make Medicare claims processing and record review faster and more accurate than ever. If you don't already have systems and processes in place to solidify your documentation, it might be time for a change.


KPMG, an intelligent automation company specializing in data-driven technologies, has developed a robotic process automation (RPA) tool that is changing the game at the Centers for Medicare and Medicaid Services (CMS) when it comes to record verification and claims processing.

Deployed earlier this year, the Intake Process Automation Tool integrates Optical Character Recognition (OCR) and other intelligent automation technologies to ingest records as they are submitted, digitize the data, and extract the information necessary to validate the record.


The Intake Process Automation Tool is fairly new but is already delivering big results for CMS in three vital areas.

  • Time-Saving – The tool is able to process a record in about ONE MINUTE. Human reviewers average about 65 minutes per record. CMS processed more than 40,000 records in 2018 and expects 50,000 this year.

  • Cost-Effectiveness – Even though the tool doesn’t completely remove humans from the review process, CMS will no longer have to pay employees and contractors to handle the highly manual, repetitive tasks that can be handled by the automation tool.

  • Increased Accuracy - The tool returns 95 percent accuracy. A test even found cases in which the tool discovered something invalid that a human had overlooked.

“If you’re looking at 1,000 pages, it’s easy as a human to miss some of these things,” said Payam Mousavi, KPMG’s lead director for intelligent automation for governments and the technical lead for the CMS project. “There are still some steps that cannot be automated or haven’t been automated yet or regulations don’t allow them to be automated,” Mousavi said. “But the expectation is that they’re going to get done faster.”


As they are submitted, this Intake Process Automation Tool will quickly examine records to identify potential problems and inconsistencies according to set parameters, submission rules, and coding guidance.

Then, the software uses OCR (Optical Character Recognition) to identify elements such as date of service, date of birth, provider and beneficiary identifiers and matches.

If that information is not detected by the automation software or if the tool isn’t highly confident about the decision it has made, the record will be flagged for human review.

A single process automation tool has processed more than 6,000 records since April 2019 and is currently saving CMS substantial amounts of time and money. Plans are already in the works to expand upon the tool, adding more validations, in the fall of this year.


Insurers and third-party payers rely on specific information in your clinical records to justify payment of a claim or to justify denial of a claim. If the information submitted is incomplete, incorrect, or inconsistent it could and very likely will result in a denial or rejection of the claim.

If you are using manual / keyboard data entry, your error rate could be 20% or more! Can you afford the loss of revenue?

You will soon submit your Medicare records to be reviewed by a very accurate, automated record checking system intentionally designed to look for very specific pieces of information within those records.

To meet the specific demands of this newly adopted automated technology, your records will need to be complete, consistent, and legible. One of the easiest and best ways to accomplish this is by adopting your own automated systems.

Document Plus offers a complete checklist data entry system that utilizes automated processes and error-checking capabilities to ensure that this very information is included in your records.

With complete, correct, consistent, and legible documentation, these automated processes could actually work to your advantage resulting in;

  • Faster claims processing

  • Fewer denials

  • Faster payment of claims

The Document Plus System is designed to streamline data collection and ensure complete, consistent, and accurate data entry through automated error checking processes. The data is then organized and stored in a format that can be easily accessed, reviewed and recalled on demand.


Will you embrace this new technology with your own automated systems or allow it to be used against you?

For a FREE DEMO of the Document Plus System contact us at 800-642-0600 or visit our website to REQUEST A DEMO.

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