Over several years, we developed our scoring system in collaboration with compliance officers and experts who have audited tens of thousands of notes. Our system is based on Medicare compliance guidelines and proving medical necessity in an outpatient PT or OT setting.

Our AI is able to read every word of every sentence in every note to classify what is and what is not contained in a sentence. We utilize over 100 sentence types and then map those sentence types to 13 core components that feed into the audit score on your Provider Snapshot. 

Within an Initial Evaluation, a Follow Up Visit, a Progress Visit, and a Discharge Visit, we know there are specific things required in each of those types of notes and they are weighted according to the importance placed on them in a Medicare audit.

What makes PredictionHealth unique is our ability to analyze both structured and the unstructured free-form text from every note in the EMR, leaving no stone unturned. Our AI reads a note sentence by sentence, 'labels' it by sentence type, and then further categorizes the sentence into a component of the audit score.

The following example shows how our AI 'maps' the note audit score components on a real example note of a Progress Visit. Everything highlighted in red indicates it is missing from the note, a yellow highlight indicates the section is under-documented, blue indicates the text was entirely copied-forward, and a green highlight indicates the component was found in the note.

It is important to understand that if a vital component of the chart is included in the note but is in a different section of the note than it would generally be located, our AI picks that up and registers it as 'found' if appropriate.

You'll also notice in the example above, not all of the text is highlighted, with the reason being that it is not included in the calculation of the note audit score. However, every sentence of the note is still analyzed and used for different purposes, such as reporting on billing and coding or clinical excellence.

Our scoring system is tough, but our goal is to help you become better and more efficient at your documentation over time to help reduce audit risk and justify all the amazing work you are doing with patients each and every day!