Clinical Documentation Improvement
Cybexys provides certified coding validation, auditing, and risk assessment services to complement your healthcare organization.
CARAT AI accurately analyzes the patient record and current documentation
to automatically detect care continuity and CDI opportunities.
Transforming Data Into Insight
CARAT leverages natural language processing and machine learning (NLP/ML) to transform structured and unstructured text including clinical information from diagnostic tests and pharmacy documentation that the provider may not have acknowledged into valuable feedback to improve documentation accuracy and glean insight into patient’s health.
Prospective Risk Adjustment
Prospective coding review is not new in healthcare. Risk-bearing organizations have attempted to reduce risk and increase top-line revenue by hiring risk coders to review the patient record before encounters to identify patient conditions that may not have been captured accurately, delivering an updated problem list.
The CARAT risk adjustment suite detects details often overlooked by coders when reviewing unstructured information from a clinician’s narrative, particularly if that data is captured in PDFs or attachments. CARAT automates this time-consuming process, accurately updating the problem list prospective to the encounter. Concurrent to the encounter, CARAT alerts providers to care opportunities consistent with M.E.A.T. criteria and suggests ICD-10 and HCC codes consistent with documentation, ensuring that payments accurately reflect a patient’s risk adjustment factor.
CARAT ProviderAssist works as an overlay in the EHR, presenting coding and documentation gaps in real-time, prospectively and concurrently to the encounter.
Analysis of the EHR, lab results, and medical and pharmacy claims, helps to identify existing or newly emerging conditions that require clinical intervention and documentation. CARAT ProviderAssist providers user-friendly alerts built into the clinical workflow within the EHR, helping providers inform their care and support clinical documentation consistent with [M]onitoring, [E]valuating, [A]ssessing, [T]reating (M.E.A.T.) criteria.
Resolve RADV Risk in Real-Time
CARAT’s prospective risk adjustment analysis helps to truly resolve RADV audit risk before it ever becomes an issue.
Traditional retrospective risk adjustment programs can detect gaps but miss the timing to provide feedback to the providers in order to close those gaps; therefore, by the time those errors are discovered the health plans, MCOs and at risk provider organizations are exposed to RADV audits amounting to high fines. On the contrary, prospective risk adjustment programs create a continuous loop of information between the health plan, MCO and providers that allows for timely resolution of both miscoding and lack of documentation.pply custom CSS to this text in the module Advanced settings.
CARAT approaches risk adjustment before the patient encounter (prospectively), alerting providers to miscoded diagnoses and requirements to add documentation that validates M.E.A.T. criteria for all coded conditions. Additionally, immediately after the encounter, providers documentation could be further validated, helping resolve RADV risk at the point of care.