In January 2024, CMS provided guidance encouraging PACE (Program of All-Inclusive Care for the Elderly) organizations to begin planning for the transition from the Risk Adjustment Processing System (RAPS) to the Encounter Data System (EDS) for submitting risk adjustment data. This is a significant change in the way PACE submits data for risk adjustment calculation.
In anticipation of the CMS announcement, AnewHealth had already begun planning to transition its Capstone Risk Adjustment Services clients to EDS effective January 1, 2025. As part of this comprehensive plan, AnewHealth is enhancing its technology to provide added capabilities, including Natural Language Processing (NLP).
NLP enables computers to interpret and produce language. It leverages machine learning and is widely used in healthcare to process and analyze data and health records, helping make more informed decisions.
The Benefits of NLP
As we become more adept at machine learning and artificial intelligence, NLP provides a foundation for greater user insight and more efficiency in reviewing records for documentation. NLP brings opportunities to ensure comprehensive assessment, complete capture of ICD-10 codes, and ultimately, optimized risk scores. These opportunities will help PACE programs remain compliant and receive accurate reimbursement for the care they provide.
AnewHealth will provide NLP capabilities through Capstone Risk Adjustment Services that support:
- More robust opportunities in audit reports
- Richer patient history and physician insights
- Real-time reporting access
- Improved granularity in reporting to participants, HCC and provider
- A streamlined and HIPAA-compliant query process
By supporting compliance and accurate reimbursement, these NLP enhancements will help optimize success for AnewHealth’s Capstone Risk Adjustment Services clients and bring peace-of-mind as CMS makes the EDS transition for PACE.
Timeline and Logistics
To ensure a smooth rollout of NLP, AnewHealth is projecting a three-phase process through the first half of 2025. AnewHealth Capstone Risk Adjustment Services clients will be updated regularly regarding NLP capabilities and changes related to the EDS transition.
To facilitate a smoother transition to EDS for PACE, CMS has expanded the use of CRRs (chart review records) but will over time want all encounters provided in the EDR (encounter data record) format. These strategic improvements will seamlessly support both CRRs and EDRs.
The addition of NLP is one way we are enhancing our technology to offer new capabilities and support clients through the EDS transition. For additional info, please contact us.
