Coding and Documentation
Get smarter medical records using proven tools and services.
Succeed with clinically intelligent solutions
We bring artificial intelligence into revenue cycle operations to help you achieve regulatory compliance and proper reimbursement. Our proprietary natural language processing (NLP) comprehends clinical documentation, identifies discrepancies and applies appropriate coding.
Our AI technology and clinical and regulatory experts help you create a high-performance environment. We surround your core systems with a rich combination of technology and expertise. This curbs errors, speeds reimbursement and improves financial performance.
You gain accurate quality reporting, improved medical necessity determinations and reduced denials. By attaining complete and accurate documentation and coding, you reduce friction with payers, rework and lost revenue.
Capture complete and accurate information throughout the patient stay
- Utilization review
- Clinical documentation
- Coding
4 of 5
U.S. hospitals rely on our information
and capabilities
10M
Medical facts and clinical algorithms
inform our NLP process
30+
Years coding content experience
Video
Artificial intelligence transforms CDI
Imagine if your team knew right away which cases had an opportunity for improvement, and where to focus. Learn how we do it with Optum CDI 3D.
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Male Speaker: Regulatory changes, and the movement towards value-based care are putting pressure on CDI encoding departments to expand their scope of work. They need to review cases for all payers, incorporate quality initiatives, and drive results around risk adjustment, without having extra staff. To meet these industry demands organizations need the right technology. The key to success is incorporating artificial intelligence like Optum natural Language Processing or NLP at the point of care.
What makes our NLP different? Optum's NLP has a unique ability to identify clinically relevant findings that indicate gaps in documentation, as well as potential quality events. It automatically reviews 100% of cases, and flags specific cases for CDI review, based on what the physician didn't say. The technology enables a more holistic program that incorporates quality reviews, conditions affecting risk adjustment, and financial impacts. NLP also concurrently translates documentation into the appropriate codes.
Complete accurate documentation and coding early in the revenue cycle means fewer denials, less rework and improved code to billing metrics. Ensure the great care provided by your organization is captured and translated into the appropriate outcomes by placing the right tools in the hands of your CDI encoding departments.
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Automated case-finding helps us quickly identify critical cases. The NLP engine recognizes the gaps in documentation that we need to address.
– Manager of clinical documentation and auditing, Midwest medical center See success story