By now, most health plan providers are aware that an efficient risk adjustment program is the key to maximizing reimbursements and improving patient care. But what’s the best way to enhance the speed and accuracy of chart reviews when today’s patient data is so voluminous and unstructured? Traditional manual processes won’t cut it anymore. Coders can’t keep pace without help, and the risk of errors or missed member charts is simply too high.
That’s where natural language processing (NLP) comes into play. NLP technology, applied properly, can actually read the unstructured patient data in medical records to help organizations better identify risk, close gaps, and improve both care quality and financial performance.
Here are four ways the use of NLP will pay off for both payers and providers moving forward:
- Better risk stratification. The more patient data to contend with, the more difficult it is for payers to ensure that every member chart is reviewed—and the more likely that high-risk members may get missed altogether. NLP-enabled technology can empower coders to quickly and easily prioritize members with the most missed conditions and the highest number of claimed codes lacking documentation.
- Increased productivity and quality of coders. When NLP does the first pass review, coders spend less time daunted by data entry and more time on QA. That translates to faster and more accurate first passes, so coders can eliminate redundancies and continue making progress.
- Improved payer-provider collaboration. As providers become more accustomed to using NLP and other insight-generating tools, payers can begin to track provider coding patterns, spot area for improvement, and help providers close coding gaps at the source.
- Frustration-free workflows. No one likes inefficient processes, particularly when they cause more work than they’re worth. NLP technology makes it easy for providers to automate data extraction and chase specific charts, without the time-consuming hassle of faxing, copying and mailing.
Before you rush off to adopt the first NLP-enabled solution you can find, however, remember that due diligence counts. The most advantageous NLP-enabled coding technology not only boasts high accuracy and precision, but also comes from a company with significant development experience in the field.
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