Predictive Modeling Software and Healthcare Reimbursement: Coming Soon to a Medicare Contractor Near You

Jim Landers, a columnist with the Dallas Morning News who writes extensively on Medicare, recently wrote about this in a column (link here, but it is behind their paywall).

Though this is really not a surprise to anyone following Medicare, PPACA (Obamacare) and the Medicare ZPIC and RAC contractors, CMS is rolling out Predictive Modeling software this summer.  And they are indicating they will use it to identify targets for fraud and abuse prosecutions.  Again, this should be no surprise to those following PPACA because in my estimation, the contractors in this region (especially the ZPIC, Health Integrity) are already doing this with Ambulance suppliers that have significant exposure in the dialysis transport market.

And what is the bottom line for healthcare providers?  Get you house in order now with a compliance program if you don’t have one – and make sure you really understand the rules related to your area of healthcare.


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