Wolters Kluwer introduces Regulatory Audit Module to improve risk adjustment audit validation rates using AI

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.

Learn more about the Regulatory Audit Module, powered by the Health Language Coder Workbench.