Artificial intelligence (AI)-enabled tools such as natural language processing (NLP) have been integrated into a wide range of applications, including risk adjustment coding tools, for greater efficiency and accuracy in the healthcare industry. For Medicare Advantage (MA) plans, these tools can significantly improve the accuracy of diagnostic and hierarchical condition category (HCC) data needed to support risk adjustment programs and help ensure appropriate reimbursement.

Preparing for new RADV changes

With NLP-driven tools, MA plans can uncover errors during retrospective chart reviews before a risk adjustment data validation (RADV) audit . Once required only for roughly 10% of MA plans each year, RADV audits will now affect all MA plans as the Centers for Medicare & Medicaid Ser

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