Second-Level Review for Risk Adjustment
Natural language processing in healthcare supports clinical decisions and coding accuracy, but not all NLP engines are created equal.

Second-Level Review for Risk Adjustment

Natural language processing in healthcare supports clinical decisions and coding accuracy, but not all NLP engines are created equal.

Why Artificial Intelligence and Natural Language Processing (NLP) in Healthcare are Indispensable

Artificial Intelligence (AI) in healthcare is critical, especially in risk assessment. It offers many benefits over traditional analytics. Artificial intelligence and natural language processing (NLP) provide more precise and accurate data which ultimately may drive better patient outcomes.

This type of advanced technology in healthcare allows medical experts to focus less on information search and entry and more on patient care.

Is 95% Coding Accuracy Good Enough?

With increasing financial pressures and compliance audits from OIG and CMS, even health plans with 95-98% coding accuracy may be putting themselves at risk. In an era of uncertainty, health systems and healthcare providers are exploring technologies to decode medical records and deliver real-time insights to improve the patient experience. And this is where AI in healthcare comes in.

Natural language processing can support clinical decision-making for providers looking for point-of-care solutions that simplify complex patient information. When it comes to coding accuracy, NLP and machine learning can be used to automatically extract risk factors associated with a medical record and help prioritize the most impactful add and delete codes.

Like any technology, NLP tools have their advantages and differences, so it is crucial to understand the challenges of integrating NLP technologies into a clinical care program. Many NLP applications intend to order unstructured data, but many still fall short.


Limitations of Natural Language Processing (NLP) in Healthcare:

Natural language Processing (NLP) has some limitations in healthcare, and they include:

  • Trained on a limited dataset
  • Poorly designed UI
  • Lack of human coder validation


Artificial Intelligence Meets Human Expertise

An effective NLP tool for second-level coding review combines targeted machine learning capabilities with the power of genuine human coders. Episource has developed a proprietary AI smart engine, trained by the industry’s most extensive bench of full-time coders who code over 14 million charts annually.

Now, what does the “AI in healthcare” movement mean? Healthcare providers and health systems can ensure complete coding accuracy and compliance—all in a single SaaS platform.

EpiFinalCheck by Episource combines the power of best-in-class NLP technology with expert HCC coders to ensure an accurate and cost-effective review of medical records.

Checkmark icon

Adhere to Regulatory Guidelines

Checkmark icon

Prioritize Interventions with the Right Adds and Deletes

Checkmark icon

Combine Machine Learning with Human Intelligence

Checkmark icon

Integrate with Multiple Data Files and Formats

Improve Coding Accuracy

Harness the power of advanced NLP to detect errors missed by prior audits automatically; have them validated by an expert coder review.

Reduce Compliance Risk

Designed to target coding errors that lead to financial and compliance risks. All NLP findings are subject to 100% QA, ensuring compliance with health plan and CMS guidelines.

Increase Program Transparency

Receive a net-impact assessment of your second level review and an independent coding accuracy assessment of your first level review, providing complete transparency into the value of new codes captured or removed.

Reduced Project Timelines

Scalable to quickly onboard new clients and handle large volumes of data, decreasing the time needed to complete projects vs. traditional chart audits while maintaining high-quality results.

Simplified Workflows

Receive a curated list of only the codes that need to be added or deleted, saving them time and effort in comparing codes from vendor to vendor and from coding to claims. Improve the accuracy of your coding program and reduce compliance risk with epiFinalCheck second-level review today.


We simplify the management of member programs by making it radically more efficient, and increasing value to healthcare organizations and their members

Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider