Wolters Kluwer introduces Regulatory Audit Module to improve risk adjustment audit validation rates using AI
April 17 2024 - 9:30AM
Business Wire
Health plan compliance teams can now access the
first AI-enabled comprehensive audit support solution on the market
as part of Coder Workbench
Health plans are under greater scrutiny, navigating an
increasingly complex regulatory environment. The Centers for
Medicare and Medicaid Services (CMS) estimates $4.7 billion will be
recovered from Risk Adjustment Data Validation (RADV) audits,
including extrapolation, from 2023 through 2032. To help mitigate
this risk, Wolters Kluwer Health has introduced the Regulatory
Audit Module as part of its Risk Adjustment solution.
The new module is specifically designed to support Medicare
Advantage Organizations (MAOs) during regulatory audits. The
Regulatory Audit Module leverages clinically trained artificial
intelligence (AI) to increase the efficiency and accuracy of risk
adjustment auditing, helping reduce repayment liability by
identifying an average of 5-7% additional codes.
Going beyond manual auditing and coding limitations
“When we first launched Coder Workbench, we worked closely with
our team of experienced clinical risk adjustment coders to deliver
a solution that solved true pain points for both the end user and
the C-suite,” said Anne Donovan, Vice President
and General Manager, Health Language, Wolters Kluwer Health.
“We’ve continued to lean on that expertise to develop the
Regulatory Audit Module, combining essential industry insight with
AI that, consistent with audit guidelines, recommends charts
appropriate to submit to achieve higher validation rates and avoid
costly penalties. There isn’t another tool on the market designed
to help health plans effectively manage these challenges
today.”
In the face of a regulatory audit, manual auditing processes
leave room for error, data loss or even corruption of data.
Further, aggregating thousands of lines of coding data can be
overly complex and burdensome, making it nearly impossible to
analyze and identify the most appropriate records to submit for a
risk adjustment audit through manual methods.
The Regulatory Audit Module is specifically designed to improve
the workflow of a risk adjustment regulatory audit and better
ensure the best encounters are submitted for higher validation
rates to mitigate the impact of extrapolated repayment
penalties.
Embedded logic and AI prioritize charts for more strategic
regulatory audit submissions
Bypassing manual processes, the Regulatory Audit Module presents
the auditor with all relevant data points with links back to the
medical record where each diagnosis was identified. The tool then
leverages embedded logic and clinically trained AI to assign a
confidence score to each hierarchical condition category (HCC),
providing coding auditors with a prioritized subset of charts for
review. The module improves the efficiency of an audit workflow by
at least 25%, allowing the MAO to navigate compressed auditing
timelines more easily.
With real-time visibility on coding and submissions, the
Regulatory Audit Module offers essential insights from the auditor
level up to the C-suite on audit progression and potential
financial impacts.
Please visit our website to learn more about the Regulatory
Audit Module, powered by the Health Language Coder Workbench.
For more information about Wolters Kluwer, please visit:
www.wolterskluwer.com
About Wolters Kluwer
Wolters Kluwer (EURONEXT: WKL) is a global leader in
information, software solutions and services for professionals in
healthcare; tax and accounting; financial and corporate compliance;
legal and regulatory; corporate performance and ESG. We help our
customers make critical decisions every day by providing expert
solutions that combine deep domain knowledge with technology and
services.
Wolters Kluwer reported 2023 annual revenues of €5.6 billion.
The group serves customers in over 180 countries, maintains
operations in over 40 countries, and employs approximately 21,400
people worldwide. The company is headquartered in Alphen aan den
Rijn, the Netherlands.
For more information, visit www.wolterskluwer.com, follow us on
LinkedIn, Facebook, YouTube and Instagram.
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version on businesswire.com: https://www.businesswire.com/news/home/20240417110813/en/
Media André Rebelo Director, External Communications
Wolters Kluwer Health +1 (781) 392-2411
andre.rebelo@wolterskluwer.com