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Review Papers | Health Sciences | United States of America | Volume 13 Issue 8, August 2024 | Popularity: 5 / 10

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Optimizing Medicare Reimbursements with Machine Learning: A Data - Driven Approach

Ginoop Chennekkattu Markose

Abstract: Health care services have developed rapidly in the United States of America thus the need to have proper reimbursement in Medicare. Some of the undesirable attributes arising from the conventional Medicare reimbursement methods include the following: the present paper outlines a method which utilizes ML to improve Medicare reimbursements. Ultimately, algorithms function with past data, trends, and prognosis. Therefore, they are beneficial in the enhancement of the reimbursement process and minimization of errors. This research, therefore seeks to establish different classes of machine learning where they are distinguished by the method employed in Medicare reimbursements; these classes are the supervised learning class, the unsupervised learning class, and the reinforcement learning class. Of all the factors that may help determine the reimbursement procedure, there are a few well known aspects that include the following: claim type, claim demographics, the treatment offered and geographical location. With the help of methods like regression analysis, classification, clustering, and deep learning, the study is to build a model to predict the probability of approval of the claim to determine the amount of payment to be made and the time to be spent on it. Taking the results above, we get the following advantages that are likely to be of assistance in reducing different costs of the Medicare reimbursement system, and effective payment for the offered services as a result of using machine learning. Moreover, the paper discusses the state of the ethics, data privacy concerns and limitations of applying machine learning in this context. In total, the identification of these challenges and the proposal for their further settlement should help to contribute to the development of the academic debate about Medicares improvement by employing up to date technology.

Keywords: Medicare Reimbursement, Machine Learning, Data - Driven Approach, Healthcare, Data Privacy

Edition: Volume 13 Issue 8, August 2024

Pages: 1558 - 1569

DOI: https://www.doi.org/10.21275/SR24825232738

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