John Snow Labs 248d ago

Hasham Ul Haq, Co-Founder & CTO at Martlet.ai, and Ritwik Jain, Co-Founder at Martlet.ai present “Preparing for RADV Audits with AI: Automating HCC Evidence Packets for Medicare Advantage.” Timestamps: (00:00) Automating HCC Coding and Audit Prep (01:06) Overview — Martlet AI and John Snow Labs (03:34) Bringing Risk Adjustment In-House (06:16) CMS 2025 RADV Audit Updates (08:41) Rising Scrutiny on Coding Evidence (09:29) Martlet AI Workflows — Prospective, Retrospective, RADV Defense (12:38) Case Study — WV Medicine & Epic Integration (15:44) Benchmarking vs GPT and Open Models (17:26) Proactive and Reactive RADV Defense Approach (19:56) Live Demo — Audit Packet Automation in Action (23:21) CMS-Ready Exports and Audit Compliance (23:48) Closing — Scalable, Defensible AI for Medicare Advantage The Centers for Medicare & Medicaid Services (CMS) is expanding the scope and rigor of Risk Adjustment Data Validation (RADV) audits, creating new challenges for Medicare Advantage organizations. Every submitted HCC must now be supported by precise, auditable clinical documentation—placing significant strain on coding teams and compliance workflows. This session introduces an AI-powered RADV platform that automates the end-to-end audit process: ingesting charts from disparate clinical systems at scale, linking each HCC to verifiable, date-bounded, provider-appropriate documentation, and routing work to coders and auditors through an opinionated review interface. The system enforces evidence sufficiency (MEAT/TP, provider type, signature/attestation, date range), maintains full provenance for every assertion, and produces CMS-ready export packets—while ensuring maximum privacy and scalability. Attendees will see how this approach combines automation with human oversight to reduce audit risk, cut administrative burden, and strengthen compliance. The presentation also shares benchmark results showing that Martlet.ai’s pipeline outperforms leading frontier models in both coding accuracy and evidence retrieval—delivering a practical, enterprise-ready solution for payers and auditors preparing for CMS’s next wave of RADV audits. ******* Install Medical LLM https://www.johnsnowlabs.com/install/ Connect with us: Our website: https://www.johnsnowlabs.com/ LinkedIn: https://www.linkedin.com/company/johnsnowlabs Facebook: https://www.facebook.com/JohnSnowLabsInc X: https://x.com/JohnSnowLabs #MedicalCoding #MedicareAdvantage #HealthcareAI #HealthcareCompliance #CMSCompliance #ComplianceAI #AIAutomation #MartletAI #JohnSnowLabs