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CaseStudy
a date of service. Once that data is in
a structured format, it’s possible to do the validations automatically for each page, Mousavi said.
“If you look at a medical record, you may have multiple names in there,” he said. “You may have the patient name, you may have the physician name, you may have a nurse name, you may have a street name. To a human, it’s pretty easy to differentiate between them, but if you have a machine looking at it, that’s where we’re using natural lan- guage processing and machine learn- ing to understand the document like a person would.”
Much of the tool is new technol- ogy that CMS did not have, Mousavi said. His team recognized the highly manual, repetitive process as a good use case for RPA, but RPA is not ideal for unstructured data or making deci- sions, he added. That’s where the KPMG Ignite AI platform comes in. It has natural language processing and
machine learning algorithms to help understand the unstructured data in the documents.
More accurate than humans
Besides saving time, Mousavi said the tool will save money because CMS won’t have to pay employees or contractors to handle repetitive tasks. Furthermore, the tool can run around the clock.
Still, it doesn’t completely remove humans from the review process. If Intake PA doesn’t have high confidence in the decision it made, the record will go to a person for verification.
“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.” And that translates to faster feedback to providers and better job satisfac- tion because employees are look-
ing only at complicated records, not checking all the information on every single one.
Another benefit is increased accu- racy. The tool returns 95 percent accuracy, and a test found cases in which the bot 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,” Mousavi said.
Since Intake PA went live in April, it has processed more than 6,000 records. Currently, CMS is using a sin- gle tool, but it hopes to have multiple bots up and running to speed the pro- cess further. In the fall, KPMG plans to add more validation details, such as checking to make sure the forms have signatures.
In May, the tool earned KPMG a spot as one of eight finalists for ACT-IAC’s Igniting Innovation awards, which highlight the newest technologies in the public sector. n
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