"An algorithm that determines coverage based on a larger data set instead of the individual patient's medical history, the physician's recommendations, or clinical notes would not be compliant [with Medicare rules enacted in April]," CMS said in the memo.
"With the use of the nH Predict AI Model ... patients rarely stay in a nursing home more than 14 days before they start receiving payment denials."
#centers-for-medicare--medicaid-services #health-insurance #ai-algorithms #government-healthcare-coverage #medicare-advantage
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