Presenter: Shane Hanley
Value-Based Care (VBC) is a health care delivery model under which providers (hospitals, labs, doctors, nurses and others) are paid based on the health outcomes of their patients and the quality of services rendered. In this model, physicians can lose visibility into how the billing codes impact their payments. In addition to errors in incorrect coding, there are often multiple correct diagnose codes available for any given patient. These typically vary based on specificity, severity or combinations of conditions. Without visibility into payment impact, doctors often select the first available code and hope that they get paid. The Chart Chasers! won three category awards at the 2022 SAS Hackathon competition: Health and Life Sciences, Natural Language Processing, and the Americas region. The team used SAS Data Science and Decisioning to build a solution for creating automatically suggested billing re-codes for medical reviewers. They implemented text analytics, business rules, workflow features, code flagging and initial start/stop/synonym lists to develop initial analytic models. The team developed a custom interface for medical coding reviewers and subject matter experts to review suggestions and provide feedback for continuous model improvement. They also used the Medicare & Medicaid Services database to calculate the Medicare Risk Adjustments. This helps hospitals and revenue cycle management organizations recover lost money due to errors and optimal alternative coding.
