Prioritizing Risk Capture Compliance with NLP
In the past few weeks, several new stories have broken around risk capture compliance issues, particularly when it comes to Medicare Advantage. Individual DOJ lawsuits around MA risk capture and government agencies like the OIG weighing in on MA policy itself have led to a barnstorm of op-eds. The crux of these stories, even the […]
The Overlooked ROI: Redaction, Chart-Linking, and CMS Penalty Avoidance
Using a workflow enabled by technology that enables, and actively supports, both additions and redaction (deletion), isn’t just easy and cost effective, it has value beyond its intrinsic ROI. Chris Gluhak explains the importance of eliminating inaccurate codes while looking for potential additions to avoid CMS penalties in audits.
Forward Looking Opportunities of NLP in Healthcare
An in-depth look at how our technology stack processes information from our NLP engine, Lumanent Insights, to derive clinical suspects and deliver them to providers.
Identifying Risk Adjustable Telehealth Patients in a Post COVID-19 World
Health Fidelity looked for a way to harness our expertise to assist our payer and provider partners provide continuity of care to their chronically ill patients. We decided to help providers identify and prioritize those patients who would be best served by telemedicine via a simple and quick suspecting report.
Illuminating Natural Language Processing in Healthcare
Natural language processing (NLP) has become a buzzword in healthcare. Organizations across the industry have moved into the space, and, for the most part, we support these moves. As an organization, we believe in the value of using artificial intelligence to support human experts in boosting the administrative stability and quality of care. Healthcare is, […]
Completeness and Accuracy in Risk Adjustment
In mid-December, the Health and Human Services Office of the Inspector General (HHS-OIG) announced that an investigation into Medicare Advantage organizations (MAO) had found $6.7 billion in potentially unsupported risk adjustment payments, generated from chart review programs that overwhelmingly yielded additional diagnoses. The study further found that 99% of chart reviews resulted in added diagnoses—not […]