WellSpan Enhances Clinical Documentation Integrity with AI Tools

The Centers for Medicare and Medicaid Services (CMS) is increasing Risk Adjustment Data Validation (RADV) audits to ensure that medical records substantiate diagnoses for payment, a shift described by WellSpan Health’s Dr. Julie Platt as a critical concern. WellSpan, in collaboration with Premier Inc.’s Stanson Health, is utilizing AI tools to enhance clinical documentation integrity in response to this regulatory change. Platt emphasized that accurate documentation is now essential for compliance and financial stability, framing Hierarchical Condition Categories (HCC) risk capture as a reflection of true patient complexity rather than just a coding exercise. The initiative aims to streamline documentation processes, improve provider engagement, and reduce workflow friction. Notably, WellSpan’s efforts include AI-driven tools that enhance diagnostic accuracy from patient visits to post-visit coding. Recent developments, including AI-driven pre-visit workflows, are expected to improve operational efficiency and support high-quality patient care.

Source link