Medical Code Prediction
Clinical Performance Analytic
Medical Code Prediction
Clinical Performance Analytic
A streamlined workflow for providers or coders to validate and summarize medical records, simplifying the review process and increasing accuracy to improve consumer care.
According to the American Health Information Management Association (AHIMA), moving to more complex diagnosis programs like ICD10 and ICD11 allow for better accuracy and improved detail that enhance care to the consumer.
Effectively managing to these standards come with a significant increase in stakeholder knowledge aligned to available codes which contributes to inconsistent code use and reduced coding accuracy. This results in loss of productivity, loss of revenue and inconsistent assignment of codes that trigger care management. Many organizations are looking for an efficient automated approach to reduce time and improve accuracy required to support the medical code assignment process.
HealthPointe’s Medical Code Prediction analytic uses Cognitive Artificial Intelligence (AI) and natural language understanding (NLU) to help reduce the painful effort to perform code evaluation. This helps reduce compliance risk, improve provider satisfaction, care coordination and billing accuracy.
Medical Code Prediction Process
1. Confirm Submitted Diagnosis
- Align actual codes to the treatment evidence
- Create problem list queue for verification of exceptions
2. Identify Codes Not Documented to the Proper Level
- Provide evidence of coding specificity due to voluminous coding standards
- Support clinical quality and better payment for proper care coordination
3. Identify Leading Indicators of Treatment Path Without Code
- Show top recommended codes aligned to care provided in clinical notes
- Add supporting evidence recommendations to justify coding recommendation
