Emedlogix offers an AI-powered platform that automates medical coding and enhances risk adjustment processes for healthcare organizations. By leveraging NLP and machine learning, it extracts ICD-10-CM and CPT codes from clinical data to improve RAF capture and ensure compliance with models like CMS-HCC V28.
Funding
Funding not disclosed
Founders
Product
Problem
Healthcare organizations face challenges in accurately capturing risk adjustment codes and optimizing revenue cycle management due to the complexity of medical documentation and evolving coding standards. Inefficient coding processes can lead to missed revenue opportunities, compliance risks, and increased administrative burdens.
Solution
Emedlogix provides an AI-driven platform that enhances medical coding accuracy and risk adjustment processes for healthcare organizations. The platform leverages Natural Language Processing (NLP) and machine learning to extract ICD-10-CM and CPT codes from structured and unstructured clinical data. This technology supports prospective, concurrent, and retrospective coding services, aiming to improve Risk Adjustment Factor (RAF) capture, ensure compliance with models like CMS-HCC V28, and streamline revenue cycle management. By automating key aspects of coding, Emedlogix enables providers to focus on patient care while optimizing financial performance.
Target Audience
The primary customers are healthcare organizations, including Value-Based Care providers, Accountable Care Organizations (ACOs), and Health Plans, as well as Revenue Cycle Management (RCM) companies.
Features
- AI-powered Computer-Assisted Coding (CAC) platform utilizing NLP and Machine Learning for medical record analysis.
- Extraction and prediction of ICD-10-CM and CPT codes across all medical specialties.
- Support for prospective, concurrent, and retrospective coding services to address various stages of patient care and data review.
- Risk Adjustment Factor (RAF) score calculation and analysis, including support for CMS-HCC Category V24 and V28 models.
- Emedlogix RIPE (Revenue Integrity Policy Engine) for AI-driven audit of pre-billing and post-billing claims to identify errors and ensure compliance.
- Emedlogix PRO for automated medical coding, including CPT search and code prediction, with EHR/EMR integration capabilities.
- Emedlogix NLP for advanced analysis of unstructured clinical data to improve coding accuracy and efficiency.
- Tools such as ICD Search and a RAF Score Calculator for direct coder and analyst support.
- Compliance with HIPAA guidelines and ISO 27001:2022 standards for data security and privacy.