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Retrospective Chart Audit Approach & Its Solution

One of the most common barriers to conducting patient chart reviews for the health care payer and providers is that various medical records may go unrecognized, which in turn, does not allow accurate risk scores calculation.

Unreported diagnosis codes encountered during a patient’s medical chart audit hampers the overall patient’s population health status which impacts the accuracy of Risk score calculation

What is a patient chart audit?

Patients chart, also known as patient medical records are valuable resources for processing patient chart audits. And, a patient medical chart audit (MCA), also known as, a retrospective chart review of patients is a process designed in which pre-recorded clinical or medical information is presented in the form of a chart and is thoroughly reviewed to calculate risk adjustment factor scores.

What is a retrospective patient chart audit?

This is an audit process, wherein, historical medical records are taken into consideration while performing the retrospective assessment. Such data can provide meaningful insights to calculate accurate risk adjustment factor scores. And, with the advancement of electronic health medical records (EMR) has made life easier for health care payers and providers.

A retrospective patient chart audit helps to understand the patterns of illness and care of a patient in hospitals and medical institutes.

Today, this methodology is being adopted by payers and medical coders to ensure accurate risk adjustment scores with the help of AI.

A chart audit in the form of retrospective assessment uncovers the potential of health care data.

How do chart audits contribute to risk score calculation?

  • Chart audits help to analyze clinical characteristics of diseases and characteristics associated with a disease or a health condition.
  • Chart audits can also evaluate the attributes of patients of specific treatment services.
  • Helps to identify the different signs of patterns for multiple disorders.
  • To spot medical errors for subsequent corrective and preventive actions.

Advisable solutions to overcome barriers to conducting patient chart audits

RAAPID’s Artificial Intelligence (AI) – Enabled Risk Adjustment Solutions is offering a modern patient chart audit workflow that not only automates repetitive tasks but also eliminates the chances of missing those unreported diagnosis codes while offering a real-time analytics dashboard to manage multiple coders to make more in less.


Patient medical records are helpful sources for conducting chart audits, however, health care payers and providers using AI can have a strategic approach to performing a comprehensive retrospective patient chart review.

A retrospective chart review of patient audits through AI uncovers some hidden gems in the form of real-time data, which in turn, is advancing the overall health care ecosystem too.


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Disclaimer: All the information, views, and opinions expressed in this blog are inspired by Healthcare IT industry trends, guidelines, and their respective web sources and are aligned with the technology innovation, products, and solutions that RAAPID offers to the Risk adjustment market space in the US.