How It Works

HIPPS DEFENSIBILITY TOOL

Where your data goes, and what touches it

Predisight reads the MDS and the documentation behind it, and returns cited findings for clinical review.

INGEST

MDS assessments and supporting documentation arrive through a secure, scheduled export. One-time setup with your IT team, then it runs on its own.

DE-IDENTIFY

Identifiers are detected and removed before clinical notes reach the analysis model. The link between a finding and a patient stays in a separate encrypted store your team controls.

ANALYZE

Rule-based logic evaluates the record against the criteria that govern defensibility. The model reads narrative and reports what the note says. It does not score, and it does not decide.

REVIEW

Findings return with severity, a plain-language explanation, and a citation. Your clinician reviews each one and decides what happens next.

ARCHITECTURE

What the model is allowed to do

THE MODEL MAY

Read clinical narrative

Report what a note states, in constrained fields

Return “not found” when something is absent from the text

THE MODEL MAY NOT

Issue a verdict

Compute a payment figure

Decide coverage

Modify the record

Act without review

Absence of a coded value means unknown, not negative. Undetermined is never reported as absent.

WHAT YOU GET

Every finding shows its work

RULE

Clinically Complex — Wound

SEVERITY

Review

FINDING

Wound measurements documented at admission. No interval reassessment found within the look-back window.

AUTHORITY

Novitas LCD L35125 · RAI Manual §M

Illustrative — synthetic data

Four things, every time — which rule fired, how serious it is, what is actually missing, and the regulation behind the requirement.

BOTH DIRECTIONS

A tool that only finds upside is not a compliance tool

Predisight reports what the record supports — whether that is more than was claimed, or less. The finding is the same either way. What you do with it is a clinical decision.

BOUNDARIES

What Predisight will not do

It will not code for you.

Findings describe what the record supports. Coding decisions belong to your MDS coordinator.

It will not tell you what to bill.

It does not select a code, compute a payment figure, or tell you what the claim should have been. Your MDS coordinator decides.

It will not submit anything.

Nothing is auto-corrected, auto-coded, or auto-filed.

It will not replace clinical judgment.

It is a second set of eyes on the record. The eyes that matter are still yours.

EARLY ACCESS

See it on a real stay

Send us a stay you have already been paid for. We will tell you what a reviewer would have found.

Thirty minutes. If it is not a fit, we will say so.

HIPPS DEFENSIBILITY TOOL​