Code Focus – Coding Intelligence Module

Real-time coding intelligence. Catch compliance issues, surface funding opportunities, and act at the point of coding — not weeks later.

For most coding teams, validation is still a retrospective exercise — issues surface through external tools or audits long after the episode is finalised, and the funding opportunity is already gone. Code Focus Coding Intelligence fixes this by running a real-time engine in the background the moment a coder sends an episode to the PAS. Within seconds, three layers of intelligence are applied and any episode requiring attention is immediately highlighted on the coder's worklist. No separate tool, no manual lookups, no waiting.

What it does:

Compliance Rules — automatically flags episodes where coding does not meet clinical coding standards, catching invalid code combinations, missing mandatory codes, and incomplete coding strings at the point of coding

ECCS Optimisation — identifies episodes where the Episode Clinical Complexity Score suggests a higher level of complexity is achievable, surfacing cases with the greatest potential dollar-value funding uplift

AI Coding Suggestions — generates code suggestions based on historical coding patterns and episode data, filtered so that only suggestions with a meaningful funding impact are presented to the coder

Closed-loop workflow — when a coder acts on a flagged episode and updates it, the engine re-runs automatically and the episode drops off the worklist once resolved

Full audit trail — every flag, suggestion, and coding change is captured and reportable, giving managers complete visibility and traceability

The results speak for themselves. Health services implementing Coding Intelligence have recovered over $500K in additional funding in their first month alone — from care already delivered, with the same team and no workflow disruption. ROI is typically visible within the first monthly reporting cycle, and the gains compound as coders and auditors direct their effort to the highest-value cases.

Coding Intelligence integrates with major PAS and EMR systems, is hosted on Microsoft Azure, and can be configured for coders, auditors, or both. Go-live is typically achievable within weeks, with existing workflows and rules migrated directly into the platform.

CodeFocus Coding Intelligence

作者 Data Agility