CONVENTIONAL
RISK ADJUSTMENT CODING
PATIENT
MEDICAL
RECORDS
HEALTH PLAN CODERS
Coders analyze and capture HCC codes from charts and submit to Health plan
REVIEW
HCC codes
of patient reviewed every year
RISK
SCORE
Health plan determines RISK SCORE of a patient based on the submitted HCC
ADJUSTMENT
CMS adjust monthly
capitated payments to Health plan based on risk score
PAYMENT
Health plan pays the provider
PATIENT CONDITION
"Unlock the potential of ML and NLP, transforming data into actionable insights!"
How Emedlogix Enhances Risk Adjustment Coding
Emedlogix-NLP, the groundbreaking Natural Language Processing (NLP) solution designed specifically for risk adjustment coding in the healthcare industry.
​
Application built on top of Advanced AI, Enhanced ML and Versatile NLP to reduce Medical Coding Errors and achieve an extremely high level of Automation, Accuracy, and Efficiency.
Prospective risk adjustment examines the patient's medical records to identify potential risks, detect emerging conditions, and provide timely support for patient care
Enhancing retrospective risk adjustment analysis with NLP, AI, and ML: accuracy, insights, performance from medical records.
Emedlogix enhances coder productivity through suggested ICD-10 and HCC codes, along with M.E.A.T. criteria justification including medication, orders & justification.
Proprietary NLP rules engine to convert diagnosis condition to diagnosis codes and HCCs to calculate risk scores
HOW RISK ADJUSTMENT CODING WORKS
REVITALIZING RISK ADJUSTMENT CODING THROUGH EMEDLOGIX NLP
STEP 1
EmedlogixNLP receives Medical records as PDF/IMAGE/WORD/
CCDA or any other formats from Health plan.
STEP 2
EmedlogixNLP
extract key terms
from medical records.
STEP 3
EmedlogixNLP converts key terms to ICD-10-CM codes.
STEP 4
EmedlogixNLP
applies ICD-10-CM, HCC & other terminology guidelines.
STEP 5
Prepares finalized list of extracted codes and publishes them.
STEP 6
EmedlogixNLP performs audits as per client-specific guidelines & compares code lists for missed opportunities and coding errors.
How Emedlogix NLP delivers codes from medical records
Recognition
Recognize medical records in any format – Word, PDF, or Image and identify medical record type.
Identification
Identify ICD-10-CM codes with precision
Extraction
Extract key information present in body of medical record and supporting documentation
Code Finalisation
Shortlist final ICD-10-CM codes and HCC values
Detection
Apply disease condition detection algorithms
Algorithm
Use AI/ML to read Coder's decision on final HCC to finetune backend algorithm
Emedlogix NLP can help achieve a significant cost reduction of minimum 30% for your organization
At Emedlogix NLP, our goal is to provide cost-effective solutions for our clients
We leverage the power of natural language processing (NLP) and large language model (LLM) to optimize coding processes and reduce expenses
By streamlining coding workflows and improving accuracy, we eliminate unnecessary expenses and increase operational efficiency.
Our advanced NLP algorithms automate coding tasks and reduce manual efforts, resulting in substantial savings.
With our cost reduction strategies, you can allocate resources more effectively and enhance your organization's financial performance.
