Press releases

M*Modal Brings Risk-Adjustment Documentation and Care Management of Patient Populations to the Next Level with a Comprehensive AI-Powered HCC Solution Suite

Published on March 7, 2018

M*Modal and SAS collaborate to give healthcare organizations accurate and reliable Risk Adjustment Factor (RAF) scores in order to prioritize and improve care across their entire patient population

Franklin, TN – March 7, 2018 – M*Modal, a leading provider of clinical documentation and Speech UnderstandingTM solutions, today announced game-changing advancements to its Hierarchical Condition Category (HCC) Management solutions to help clients significantly improve risk-adjustment performance. The first and only complete HCC solution in the market today, the M*Modal suite is patient-focused and quality-centric to help risk-bearing healthcare organizations proactively meet the challenges of the HCC model by accurately capturing the disease burden and RAF scores. M*Modal is showcasing its HCC Management solution suite at the 2018 HIMSS Conference (booth # 4416through March 8.

At a time when managing patients with chronic conditions has become increasingly vital, M*Modal helps clients take a comprehensive approach to better understand the true health needs of their patient populations while driving outcomes based on both provider and payer information. Using advanced artificial intelligence (AI) and natural language understanding (NLU) technologies, M*Modal solutions bring differentiating clinical intelligence, automation and workflow efficiencies that can scale to the significantly larger volume of ambulatory-care documentation.

M*Modal risk-adjustment solutions using HCCs enable doctors, population health specialists, auditors and coders to easily find and close gaps at the point of care by pre-identifying HCCs that need to be captured in the current year for a scheduled patient visit. The M*Modal technology identifies health conditions from structured and unstructured data to schedule patient visits and follow-ups, and then helps capture the required documentation. The M*Modal NLU technology even flags diagnoses indicated in physician documentation but not included in a bill. These HCC solutions work seamlessly with all M*Modal products and services, including the newly-launched Virtual Provider Assistant, as the Company’s entire portfolio is built on a single, cloud-based and EHR-integrated speech and AI platform.

“Healthcare organizations are facing steep challenges with value-based care. We are pleased to provide a comprehensive solution suite that meets a growing market need,” said Scott MacKenzie, CEO of M*Modal. “Our patient-focused HCC solutions utilize both AI and coding to ensure continuity of care while enabling clients to focus on areas of greatest impact and improve outcomes.”

M*Modal HCC ManagementTM solutions include:

Proactive Front-End Physician Support: M*Modal provides real-time insights on HCC opportunities and codes as well as patient disease states, problems, needs and goals  to physicians at the point of care, starting with patient-specific information related to chronic conditions in preparation for the patient visit. Leveraging widely-adopted M*Modal Computer-Assisted Physician Documentation (CAPD) that works with all market-leading EHRs, M*Modal HCC EngageTM proactively assists with summarizing patient-specific needs and requirements in connection with value-based care across multiple systems in the practice environment. Creating time to care, this solution ensures that clinicians capture the most specific disease categories at the first go and within their normal EHR workflow for optimal quality and reimbursement.

Back-End Auditing Workflow: M*Modal identifies potential risk-adjustment opportunities by using leading-edge AI and NLU technologies to analyze previous years’ claims, EHR structured data, and narrative clinical documentation. M*Modal HCC Collaborate helps auditors prioritize patients to be scheduled based on gaps in their risk score and effectively review physician documentation. Supported by robust analytics and reporting, this solution enables clients to turn insights into outcomes and continually improve risk-capture protocols.

RAF Score Management: M*Modal has collaborated with SAS to calculate a RAF score for all patients in a facility’s patient population. With this unique transparency, auditors can immediately identify gaps in the capture of chronic conditions from year to year. This solution gives healthcare organizations a true and accurate risk score based on the same data models used by CMS (Centers for Medicare & Medicaid Services) and a complete understanding of each patient’s complexity.

About M*Modal

M*Modal is a leading healthcare technology provider of advanced clinical documentation solutions, enabling hospitals and physicians to enrich the content of patient electronic health records (EHR) for improved healthcare and comprehensive billing integrity. As one of the largest clinical transcription service providers in the U.S., with a global network of medical editors, M*Modal also provides advanced cloud-based Speech Understanding technology and data analytics that enable physicians and clinicians to include the context of their patient narratives into electronic health records in a single step, further enhancing their productivity and the cost-saving efficiency and quality of patient care at the point of care. For more information, please visit https://mmodal.comTwitterFacebook and YouTube.

Media Contact:
Aparna Prabhakar