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Is 95% Coding Accuracy Good Enough? The Power of NLP-Targeted Second-Level Review

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December 8, 2021

When it comes to coding accuracy, 95% has become industry standard — but it doesn’t have to be.

With the Office of the Inspector General (OIG) sounding the alarm on billions of potentially improper payments to Medicare Advantage organizations, ensuring full coding accuracy and compliance is more important than ever. Episource’s Chief Operating Officer, Erik Simonsen, explains how to leverage NLP in your second-level reviews to provide an efficient, cost-effective way to automatically detect errors missed by prior audits. Download our presentation slides from the 18th RISE Risk Adjustment Forum conference.

Key Takeaways:

  • Understand the challenges and risks associated with under- and over-coding
  • Examine differences between NLP engines and calculate how to leverage NLP-powered second-level reviews to “look both ways”
  • Learn how to close the loop and improve future documentation

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