Rules Engine

Medical Coding, especially charge determination for subjective services such as E&M Level determination and Performance Measures, or services based on verbose documentation such as Surgical Procedures, requires many rules to be evaluated before arriving at the correct charge. In addition, individual healthcare providers may have their own overlay policies with respect to what is allowed and not. In most cases, these rules need to be evaluated based on clinically relevant content in free text encounter documentation. For example, E&M Level for professional coding and for ER Coding may be upward of 100 rules. Likewise, ER Departments typically charge for 100 or more procedures such as laceration repair, fracture reduction, incision and drainage, foreign body removal and burn care performed in ER by the ER Physicians.

To cater to the above application scenarios, Medical Savant software platform comprises an NLP integrated Rules Engine. Individual application scenarios can its own set of rules (a.k.a. rule based application) that can be configured into the system. Medical Savant rules engine allows rules to be updated dynamically as and when new rules are detected/identified or current rules are modified, without disrupting the functioning of the application or the end user access.