Under the Hood: The AI-Assisted Risk Adjustment Workflow

The term "AI" is everywhere in healthcare technology, but what does it actually mean when applied to the complex world of HCC risk adjustment? It's more than just a buzzword for faster processing. A truly intelligent platform re-engineers the workflow for enhanced collaboration between your expert coders and powerful technology.

At MedChartScan, we believe in transparency. We want to show you exactly what our "AI-powered" platform does under the hood to help your team achieve enhanced accuracy and efficiency with full confidence.

Step 1: Providing a Complete Clinical Picture

A coder's decision is only as good as the data they can access. The reality for most healthcare organizations is that critical information is scattered across dozens of formats. Our platform's first job is to bring it all together.

Our engine is built to process a complete, panoramic view of a patient's health by handling:

• Unstructured Documents: This is where our technology truly shines. We leverage state-of-the-art LLM vision models to see and understand a document's layout, tables, and text. This superior comprehension ensures that no detail is lost in translation, giving your team access to insights from the single biggest opportunity in risk adjustment.
• Structured Data: We also integrate directly with your existing systems, processing structured data from claims feeds, HL7 messages, and EHR data exports to build a comprehensive patient history.

This ensures your team has the most complete picture possible before making a coding decision.

Step 2: Surfacing Potential Clinical Connections

This is where most basic tools fall short. Our AI was developed in direct collaboration with practicing medical specialists to recognize clinical patterns and context.

This means our platform doesn't just find keywords; it's trained to surface potential links that a human might miss under time pressure. It can:

• Differentiate between an active diagnosis and a condition noted in family history.
• Surface potential links between a manifestation (e.g., neuropathy) and its underlying cause (e.g., diabetes) even if they are mentioned pages apart.
• Recognize and highlight the clinical indicators that may support a diagnosis, helping coders validate MEAT criteria. See a real-world demonstration of this support process.

Step 3: Empowering Coders with Actionable Insights

Surfacing a potential HCC is useless if it doesn't seamlessly integrate into your team's workflow and provide a clear, defensible audit trail.

• Evidence-Based Suggestions: Every potential code MedChartScan surfaces is hyperlinked directly to the supporting evidence in the source document. Your coders can see the relevant text highlighted instantly, allowing them to validate suggestions in seconds, not minutes.
• Seamless Integration: Documents can be uploaded securely or fed from your EHR. The system processes charts in minutes, presenting coders with a prioritized list of opportunities for their expert review.
• Dynamic Risk Monitoring: As your team reviews and accepts suggestions, the platform provides a real-time view of patient and portfolio risk scores, allowing you to track the impact of your team's work.

Step 4: Providing Your Team with Instant-Access Intelligence

For most organizations, patient records become a digital black hole. We turn that archive into a live, searchable asset for your team.

MedChartScan indexes every word and concept from every document, powering our intelligent semantic search engine. This gives your team a Google-like search bar for your entire patient database. This capability is invaluable for supporting CDI queries and is the foundation for building a truly proactive CDI program.

The Result: A Safer, More Efficient Workflow

By re-engineering the process for collaboration, the impact is felt across the organization.

• Enhanced Revenue Accuracy: By pairing comprehensive AI review with expert human validation, you ensure all legitimate, billable conditions are captured accurately and defensibly.
• Strengthened Audit Defense: With a complete, human-validated documentation trail for every captured code, responding to audits becomes a simple, streamlined process.
• Boosted Team Efficiency: By automating the time-consuming initial chart review, MedChartScan frees your expert coders from tedious searching to focus on high-value validation. This collaborative approach is how teams can boost efficiency by up to 10x while maintaining the highest standards of quality.

The future of risk adjustment is about smarter collaboration between technology and human expertise. By combining comprehensive data processing with deep clinical intelligence, we provide a platform that enhances your team's capabilities and protects your bottom line.

*Reading about it is one thing. Seeing it is another. Contact us to schedule a live demo and we'll show you how our AI can empower your team._