Healthcare IT Today September 16, 2021
The following is a guest article by Pranay Jain, CEO and Co-founder of Enterprise Bot.
The Health Insurance Portability and Accountability Act (HIPAA) was introduced in 1996 mainly to help migrate insurance coverage details of employees between organizations, prevent insurance fraud, reduce wastage of medical resources and eliminate improper payments.
In a study by the Centers for Medicare and Medicaid Services (CMS), it was observed that over 8% of all healthcare payments were improper in 2018 alone.
To reduce all forms of erroneous payments, CMS introduced a testing practice known as Comprehensive Error Rate Testing (CERT). The methodology employs engineered AI algorithms and Predictive Analytics to detect fraudulent healthcare payments and other forms of payment-related errors. By doing so, the...