Innovative tools to support retrospective risk adjustment chart review and regulatory audits

Health plans today are challenged with optimizing risk adjustment processes amidst escalating costs and increasing regulatory audits. The importance of accurate, efficient coding and data management practices cannot be overstated, especially considering the restarting of CMS RADV audits as well as the recent intensification of audits by the Office of Inspector General (OIG).

The Health Language Coder Workbench not only responds to these challenges but sets a new standard for excellence in the field. Leveraging the power of the Health Language Data Platform, the Coder Workbench combines clinically trained AI technology and semantically enriched medical terminology libraries.. We incorporate risk adjustment coding intelligence to ensure diagnoses that are coded are in alignment with the official guidelines for compliant coding and reporting, empowering health plans to navigate the complexities of risk adjustment with confidence and precision.

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Key benefits of the Coder Workbench for health plans

Advanced technology to support compliance

Clinically trained AI captures context and ensures HCCs coded are in alignment with official guidelines for compliant coding and reporting. 

Clinically accurate tools 

Reduce review times, increase audit volume, and expedite quality assurance with over 95% accuracy rates. 

Intuitive user interface 

Built by coders and audit experts, our application organizes medical charts in a user-friendly format to improve workflow processes. 

Speak to an expert to learn more about the Health Language Coder Workbench 
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Delivering value to your Medicare Advantage Organization

25-30%

Increased efficiency over manual chart review.

5-7%

Net new codes identified and accepted by the client.

10-15x

Approximate ROI generated for a pilot evaluation of 100 charts.

Featured resources on Risk Adjustment

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OIG investigations: How your risk adjustment team can improve compliance 
Watch this webinar on improving risk adjustment compliance and preparing for OIG audits. Learn about avoidable coding errors, financial impacts, and available tools to avoid penalties. 
Access The Webinar
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Clinically trained AI technology helps MA plan fend off CMS audits 
Medicare Advantage Organizations need to increase the accuracy of risk adjustment coding. Read more to learn three key strategies health plans can use to navigate the shifting seas of risk adjustment. 
Read Whitepaper
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It’s not IF, it’s WHEN: Best practices to survive a RADV audit 
Is your organization ready for the next RADV audit? In this webinar conducted in partnership with RISE, our risk adjustment experts discuss best practices, strategies, and tips for audit preparedness. 
Access The Webinar

Transforming current risk adjustment processes

Gone are the days of manually reviewing each patient’s records and inputting data into cumbersome spreadsheets. The Health Language Coder Workbench organizes the chart, identifying present HCCs and linking them directly to supporting evidence within the medical record, and offers real-time visibility into coding progress and team projects.

A revolution in preparing for risk adjustment regulatory audits

At the heart of our latest innovation is the Regulatory Audit Module, a cutting-edge tool designed to streamline the workflow of any regulatory risk adjustment audit (i.e RADV, IPM, OIG). This module ensures the very best encounters are submitted for validation, significantly reducing extrapolation payment penalties and safeguarding your organization against noncompliance publicity. The module can also be utilized for internal audits, mock audits, and vendor audits.

Smart chart organization 
The user interface creates a table of contents within the medical chart for coders to navigate sections efficiently. 
Built-in coding assistant 
Auto-populate and code refinement tools ensure complete and accurate ICD-10 and HCC code capture for maximum coder review speed and accuracy. 
Embedded coding guidelines 
Medicare Advantage code-specific guidelines and logic are integrated to ensure sufficient evidence for code capture. 
Chart prioritization
Improve coding workflow and efficiency by properly assigning the right coder to projects based on skill and chart value.
Clinically trained AI technology  
Advanced technology trained to understand and extract clinical indicators captured in unstructured text within the medical record. 
Expert-authored clinical terminologies 
Semantically enriched terminology libraries ensure superior ICD-10 code refinement. 
Regulatory audit support
Intuitive UI supports coders by analyzing coded charts to recommend the best charts for submission to ensure the highest validation rates. 
Project management dashboard
Customized user interface and reporting capabilities for regulatory audit projects improves efficiency and reduces errors. 

Learn more about the Health Language Coder Workbench

Learn how the Health Language risk adjustment solution can support your risk adjustment processes. Complete the form below and we'll be in contact with you soon.

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