The utilization of NLP to read records and find HCC codes in Medicare Advantage health plans offers improved accuracy, increased efficiency, enhanced coding compliance, real-time risk assessment, and improved member care. These benefits can lead to financial gains, operational efficiency, and better patient outcomesfor the health plan.
Key Benefits:
Improved accuracy:
NLP technology can effectively analyze and interpret unstructured medical data, such as physician notes, discharge summaries, and diagnostic reports. By automating the process, NLP reduces the risk of human error and improves the accuracy of HCC code identification. This accuracy ensures appropriate risk adjustment for patients, which is crucial for Medicare Advantage plans to receive appropriate reimbursement.
Increased efficiency:
Manually reviewing medical records to extract HCC codes can be a time-consuming and resource-intensive task. NLP can expedite this process by quickly scanning and extracting relevant information from large volumes of medical records. This increased efficiency allows health plans to process more records in less time, resulting in cost savings and improved productivity.
Enhanced coding compliance:
Medicare Advantage plans need to comply with coding guidelines and regulations set forth by the Centers for Medicare and Medicaid Services(CMS). NLP algorithms can be trained to adhere to these guidelines, ensuring accurate and compliant coding practices. This reduces the risk of incorrect coding, potential audit penalties, and financial loss due to non-compliance.
Real-time risk assessment:
NLP-powered HCC coding can provide health plans with real-time risk assessment for their enrolled members. By continuously analyzing and updating medical records, NLP algorithms can identify and flag potential HCC codes that may have been missed during previous coding cycles. This enables health plans to capture accurate risk scores, leading to appropriate care coordination and revenue optimization.
Improved member care:
NLP technology can extract relevant clinical information from medical records beyond HCC coding, such as medication history, comorbidities, and social determinants of health. This holistic view of the patient can help identify care gaps, support disease management, and facilitate personalized care interventions. Ultimately, this can result in better health outcomes for Medicare Advantage plan members.
david.rothermel@eclathealth.com | ECLATHEALTH.COM
