Accurately capture and document risk-adjustable conditions
Finding and sustaining resources with the expertise to accurately code risk-adjustable conditions—while also ensuring regulatory compliance—can be difficult. Although new technologies, such as artificial intelligence (AI) and natural language processing (NLP) can augment coding efficiency, these tools can’t entirely replace the expertise of a certified coding professional. Health plans need a partner with the scale, resources, and flexibility to manage compliant coding efficiently and effectively.
Cotiviti’s AAPC- or AHIMA-certified clinician coders have an in-depth understanding of risk adjustment coding standards and specific Centers for Medicare & Medicaid Services (CMS) rules and guidelines. Our coders review digitized medical records, considering the appropriate diagnosis condition hierarchies and interactions. They provide thorough code capture from a member’s medical chart to ensure that all appropriate diagnoses are identified and supported in preparation for submission to CMS. On average, 96 percent of Medicare charts suspected, retrieved, and coded by the Cotiviti Risk Adjustment team contained undocumented chronic conditions.
Achieve >95 percent coding accuracy
Improve coding project turnaround times
Facilitate provider education on appropriate medical chart coding
Improve submissions compliance
Reduce risk adjustment data validation (RADV) audit risk
Our people are at the core of our processes. Our domain expertise includes clinical and technical knowledge in machine learning, pattern recognition, and NLP, allowing us to deploy AI purposefully to drive value throughout our risk adjustment workflow. For medical record coding, AI-enabled processes complement the talents of our approximately 1,000 certified coding professionals to benefit our customers through:
For additional Medicare and commercial risk adjustment compliance confidence, Cotiviti can compare claims and encounter data with medical chart coding data through our optional Coding Compliance Review (CCR) process. CCR highlights discrepancies between the medical claim data submitted and the first-pass coding of associated medical charts. If the coder cannot validate the HCC, it will be marked for deletion and sent to the client for final determination.
This extra layer of review not only increases a plan’s confidence that the HCCs submitted to CMS have validated diagnoses, but also helps strengthen payer-provider relationships. Plans receive reports from Cotiviti indicating which providers are consistently submitting incorrect claims, allowing them to proactively reach out with educational support.
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Medical Record Coding is part of Cotiviti’s Risk Adjustment solution suite.