Medical Record Coding

Accurately capture and document risk-adjustable
conditions

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Medical Record Coding is part of Cotiviti's
Risk Adjustment solution suite.

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Medical record coding is complex, with guidelines and requirements that are constantly evolving. Health plans need a trusted partner to reduce complexity and manage coding effectively at scale.


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>97%

average coding accuracy

Cotiviti's Medical Record Coding solution delivers high quality results that enable health plans to accurately capture their population risk.

Medical Record Coding everages natural language processing (NLP) technologies to augment coding efficiency, integrating them with expert leadership, an in-depth understanding of the healthcare industry, and proven best practices and processes to drive success and compliance. 

Plans can also add our Second Level Review solution for charts previously coded, adding an extra layer of protection, improving performance, and responding to the need to manage growing complexity.

Medical Record Coding results

>10M

charts coded in 2023

>97%

average coding accuracy

>$2B

average appropriate incremental risk adjustment revenue delivered to clients annually

 

Medical Record Coding benefits

Our people are at the core of our processes. 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 domain expertise includes clinical and technical knowledge in machine learning, pattern recognition, and NLP, allowing us to integrate technology innovations effectively to drive value for our health plan clients.

For medical record coding, AI-enabled processes complement the talents of our certified coding professionals to benefit our customers through:

  • Improved accuracy: Our commitment to quality ensures that relevant codes and clinical context are included as part of our extensive certified coder chart review.
  • Enhanced compliance: Through our advanced technology, we capture complex combinations of conditions and severity levels that could be missed by manual coding alone.
  • Greater consistency: We ensure that complex coding guidelines, including national and customer-specific nuances, are best applied across different patient populations, coders, and risk adjustment seasons.

What makes Cotiviti different?

With Medical Record Coding, plans benefit from a variety of features that make Cotiviti stand out against the competition

  • Consistent quality at scale
  • Highly trained AAPC- or AHIMA-certified coders
  • Leading training and QA expertise
  • NLP and technology-powered efficiency
  • >25 years of experience partnering with national and regional health plans

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