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How New Risk Adjustment Technology Affects Coders

This is the fourth in a 4-part series called Intro to Risk Adjustment Technology.

Risk adjustment is traditionally done in a manual and inefficient way, as we have discussed throughout this blog series. Coders will comb through thousands of pages of patient charts and look for documented chronic conditions. This process is time consuming and costly, not to mention that it doesn’t make good use of coders’ expertise.

Cognitive computing is transforming risk adjustment

There is a technology solution that can address this— cognitive computing. A cognitive computing platform acquires patient charts, and reads and analyzes the data within them for potential HCC information. After the platform analyses all the charts, it finds evidence for chronic conditions and gathers it into individual bundles for each potential HCC per patient. Coders then go through the bundles of findings and accept or reject them.

It’s a brave new world, and coders have a new, better role

The important question is: where does this leave coders? Is there a place for me in this new era of cognitive computing risk adjustment? The short and long answer is: yes. These platforms do great work, but it is still essential for a coder with experience and subject-matter expertise to review and audit their work.

The technology does shift coders into a new role though. This role requires less mechanical labor and significantly more technical knowledge, management and audit responsibilities.

The new technology means a lot of the most painful work of coding is done for you. Thousands of charts are analyzed, and the conditions and supporting evidence displayed for you, ahead of time. This is very different from the past, when coders would have to physically gather charts, separate them by hand, keep track of them, and assemble them. In fact, clerical work was so critical to the coder role that job descriptions often required that coders be able to lift 40 pounds.

The new technology also gives greater management, analytical and review responsibilities to coders. Every HCC that is presented to coders is a potential opportunity that requires close attention. To use a baseball analogy, it would be like going from seeing one good pitch an inning, to seeing ten; with that kind of material, you’re expected to hit home runs.

Real, accurate, coding insights are now possible

The new technology also allows for greater insights into your coding activity performance and facilitates organizational growth. Because all the risk adjustment work is tracked electronically, it’s very easy to see with great detail how a project went. Understanding how fast work was done, how documentation accuracy increased and decreased over time, how productive individual coders were, all this is very easy to find out. Using these insights, project managers can help coders improve and advance to the forefront of their profession. Technology, in this case is not only a productivity tool, it can be an education tool as well.

These insights extend to the organization as a whole. With electronic tracking, it’s simple to keep track of HCC history, and for the next year’s submissions, create reminders for providers to address diagnosis issues and remove anything that is not accurate or no longer present. It allows us greater insight on spotting trends, identifying HCCs which providers were missing, or determine where opportunities exist to improve provider training.

Technology is transforming risk adjustment in massive ways, making it more accurate, efficient, and productive. Coders have an important place in this new world, but only if they accept a different role— a better one, in fact— than they had in the past.

To learn more see parts I, II, and III of this series.

Part I: Why Does Risk Adjustment Need Technology?

Part II: How We Use Technology to Get Risk Adjustment Data Out of EHRs

Part III: How We Use Machine Learning to Analyze Patient Data in Medical Records

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