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AssigneeApixio, Inc.
InventorsJohn O. Schneider, Vishnuvyas Sethumadhavan, Darren Matthew Schulte, Robert Derward Rogers
Estimating the term…
Systems and methods for managing audit risks utilizing the true state of the patient are provided. A number of medical records for a patient are subjected to predictive modeling for various conditions (known as patient ‘true state’). The true state is then cross referenced by the eligible Medicare documentation, and any findings that are being submitted to MediCare for reimbursement. The result of this cross referencing is the ability to classify each finding and/or true state into a “green, “yellow”, or “red zone”. The green zone is where the finding, documentation and true state are in good alignment. A red zone is where the finding and the true state are entirely at odds. The yellow zone is where the findings and the true state are in agreement, but where there is still audit risk that may be resolved through one or more “opportunities”.
A health information system comprising:
A computer-implemented method implemented by a health information system including a data warehouse manager and a first pass analyzer, the method comprising:
At least one non-transitory computer-readable storage medium having computer-executable instructions embodied thereon, wherein when executed by at least one processor of a health information system including a data warehouse manager and a first pass analyzer, the computer-executable instructions cause the at least one processor to:
Dependencies are inferred from the claim text.