Season 2 • Episode 6

NLP For Coding & Compliance


Show Notes

NLP is an AI technology that is being used in healthcare IT for clinical documentation and medical coding. For medical coding, the program identifies diagnoses codes for HCC risk adjustable categories and flags it for a medical coder to review. 

In robust medical charts that span up to thousands of pages in length, this enables coders with an automated way to identify diagnoses codes for review, hence increases speed, efficiency, and output. Academic research has found NLP increases medical coding productivity by 15-20%. 

After the medical chart is reviewed by a medical coder, the chart goes through a pre-submission QA process for accuracy and compliance review. In some cases the chart will go through the NLP program for a second pass to identify additional insights and potential missed opportunities. 

Tune in to this episode to learn: 

  • Additional opportunities and limitations of NLP 
  • Why medical coders are needed now more than ever
  • How organizational goals influence the way plans customize their NLP engine

About Our Guest

Kristi Reyes is the the Director of Risk Adjustment Coding Operations. She leads a team of 250 medical coders from various aspects of risk adjustment—including retrospective, prospective, CDI, QA, risk mitigation, and RADV. Kristi holds certifications in Certified Professional and Outpatient Coding, Risk Adjustment Coding, and Auditing.

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