Medical Record Coding

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% of Medicare charts suspected, retrieved, and coded by the Cotiviti Risk Adjustment team contained undocumented chronic conditions.

Benefits

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.