How to Improve Risk Adjustment With NLP

How to Improve Risk Adjustment With NLP

Posted Apr 14, 2021 from
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From a risk adjustment standpoint, NLP can read physician documentation, identify the vital clinical facts, and map those facts back to ICD-10 codes without human intervention. Human coders validate the resulting codes and return them to health plans tackling risk adjustment, which are further evaluated and submitted directly to CMS.

By pairing your NLP technology with AI and machine learning, it is possible to take risk adjustment and quality programs into a new phase of technological capability. NLP enhances your ability to detect conditions based on coding patterns or leading health indicators while providing additional visibility into the patient populations based on clinical documentation. 

You can spot trends and find critical clinical information in what would otherwise be a stack of contemporaneous notes or an aggregated data set far too large for one person’s consumption.

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