Medicare Advantage Plan Identifies Unrealized Reimbursement with NLP-Powered Second Level Review

Despite having 98% coding accuracy and undergoing two rounds of reviews by two separate coding vendors, a leading health plan decided to pilot a new coding solution from Episource—and unlocked an additional $43/chart.

Episource approached one of their long-term clients to conduct an introductory pilot of epiFinalCheck—an NLP-powered coding review product. The process required the plan to provide charts which had already been reviewed. The plan routinely conducted multiple levels of review and was satisfied with the high level of accuracy they were receiving, but they agreed to let Episource evaluate the charts to identify any overcoding or undercoding issues in these already very accurate coding results.

The Challenges:

  • Improve Coding Accuracy
  • Identify Net New or Unique HCCs and Unrealized Reimbursement

Download this case study to learn more about Episource’s approach and the solution that was implemented to drive results for one of the largest Medicare Advantage plans in the U.S.


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