Medical Record Coding

Accurately capture and document risk-adjustable conditions

The facts

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.

Benefits

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

Experienced people with deep industry expertise

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:

  • Improved accuracy: Our commitment to quality ensures that relevant codes and clinical context are not missed 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 may be missed by manual coding alone.
  • Greater consistency: We ensure that complex coding guidelines, incorporating national and customer-specific nuances, are applied in the same manner across different patient populations, coders, and risk adjustment seasons.

 

An extra layer of confidence

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.

Lorem ipsum dolor sit amet

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

Results that speak for themselves

Subtitle

Card Title

Card Body

Subtitle

Card Title

Card Body

Subtitle

Card Title

Card Body

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

Get your fact sheet today