Our Retrospective Chart Audit solution assesses coder ROI, Clinical documentation, and CDI opportunities, reducing physician queries and improving code assignment specificity for improved risk score accuracy.
Evaluate RAF scores for enhanced reimbursement and financial performance.
Ensures regulatory compliance, reducing audit risks and penalties.
Identifies reimbursement opportunities, boosting revenue for healthcare organizations.
Utilizes audit insights for efficient resource allocation and decision-making.
Enhances coding proficiency and accuracy through education and training initiatives.
Insights from our Retrospective Chart Audit facilitate stakeholders to work collaboratively towards the shared goal of meeting compliance requirements and delivering high-value, patient-centered care.
We benefit all our Audience.
Retrospective chart audits enable plans to uncover discrepancies in billing practices, coding patterns, and utilization, thereby safeguarding against potential fraud and abuse while promoting fiscal responsibility.
Retrospective chart audits provide valuable insights into care delivery patterns, care coordination efforts, and opportunities for care standardization across the network.
Retrospective chart audits help identify and address documentation deficiencies, reducing the likelihood of compliance issues and audit penalties.
Potential diagnosis codes not captured in the documentation and which could impact risk adjustment and reimbursement
Inaccurate HCC coding, documentation deficiencies, and non-adherence to Medicare Advantage program regulations result in audit scrutiny and penalties.
In the pre-audit phase, clinical teams face heavy workloads, meeting deadlines with manual chart reviews, worsening inefficiencies, and causing team burnout.
We optimize reimbursement and compliance while enhancing coding accuracy through RAF score evaluation, documentation improvement, and data-driven decision-making with coder education.
Thorough analysis by skilled coders ensures a comprehensive assessment of medical records for accuracy.
Ensures adherence to regulatory standards, minimizing audit risks and penalties for non-compliance.
AI assists in identifying potential ICD-10-CM & HCC coding errors, enhancing accuracy and efficiency in auditing.
Provides actionable insights for remediation and process improvement, driving better outcomes and compliance.
Our solution experts have broad experience in various Risk Adjustment AUDIT scenarios, promoting compliance synergy throughout clinical workflows.
Implementing NLP technology automates the review and audit of diagnoses, saving time and improving the transparency of audit trails to ensure compliance as per regulatory standards.
The adoption of automated processes for capturing and verifying HCC codes in accordance with the MEAT risk adjustment guidelines ensures adherence to regulatory requirements and enhances the accuracy and integrity of reported data.
Leveraging Knowledge Graph algorithms to extract historically relevant data from unstructured clinical notes enhances data integrity and facilitates accurate reporting for audit and compliance purposes.
Through the capture of subtle nuances in past patient diagnoses and comorbidities, in-built AI-powered diagnosis strengthens compliance efforts by ensuring accurate reporting and alignment with regulatory requirements.
NLP-powered risk adjustment solutions streamline workflow processes, this ensures timely and accurate reporting, promoting audit readiness and compliance with regulatory standards.
Our full spectrum of Retrospective Chart Audit Services supports health plans responding to CMS audit notices and assists HCC medical coders in ensuring accuracy during pre-claim submission.
Our AI-powered retrospective chart audits optimize healthcare operations by maximizing efficiency, accuracy, and revenue while promoting patient outcomes & care delivery.
Our Customizable Retrospective Audit Solutions
Leave all your technological concerns behind – we will take care of it. Let’s move forward from Risk to Revenue
