Medicare risk adjustment is a rule-based calculation, based on seven variables: ICD Codes of the patient’s diagnoses, age, gender, eligibility segment, entitlement reason, Medicaid status, and if the patient is disabled. All variables are picked from structured data – claims or EMR. NLP is applied to derive missed ICD codes resulting in lower risk adjustments for patient, which hurt the revenue of the provider/ACO taking the risk on them or underestimate the risk for payers insuring the patient.
Databricks scalable data lakehouse environment helps healthcare organizations to enable reporting capabilities using such automated patient risk adjustment and advanced Medicare HCC coding. Azure Databricks embedded in Azure cloud delivers a secure, enterprise-ready environment using the capabilities of Spark NLP for Healthcare achieving this goal for payers or at-risk providers.
This session focusses on the end-to-end delivery of automated Patient Risk Adjustment and Medicare HCC Coding from Clinical Notes.