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Medicare Payment Standardization Modeling using SAS Enterprise Miner (EM)

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Medicare Payment Standardization Modeling using SAS Enterprise Miner (EM)

Michelle Roozeboom, Ph.D.
Buccaneer Computer Systems and Software, Inc.

ABSTRACT

The CMS Policy and Data Analysis Group (PDAG) contracted with Buccaneer to develop Medicare Part A and B standardized claim payment files. Standardized payments have been computed for 100% of the administrative fee for service claims data for 2007 and 2008 (2009 is being developed). The current standardization process re-computes the Medicare payment for each claim by removing the geographic components from the payment algorithms for each type of service.

Buccaneer is exploring ways to streamline and automate the process of standardizing Medicare payments. One method we are investigating is to build predictive models using SAS Enterprise Miner (EM) that would be used to compute the standardized payment based on the relevant characteristics of the service performed.

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