First solution—Malnutrition Care Automation—generates $1.4M in annualized reimbursement for southern academic medical center by identifying missed diagnoses, orchestrating timely care and completing documentation
San Francisco, CA – Qventus, the leading provider of AI-powered care operations automation, today launched the Care Gap and Coding Automation Suite—a first-of-its-kind solution suite that identifies missed diagnoses, orchestrates timely clinical interventions, and completes documentation in real time. Fully embedded in provider EHR workflows, the solution offloads manual documentation work for care teams while ensuring reimbursement reflects the complexity of care. The first solution in the suite, Malnutrition Care Automation, is live today.
Undertriaged Conditions Drive Quality Gaps and Lost Reimbursement
Today, many complex conditions are undertriaged and undertreated, impacting the quality of care and creating a significant reimbursement gap. CDI teams audit charts 24–48 hours after care—long after the window for meaningful intervention has closed—and the consequences are severe:
- Missing or under-documented complex conditions—severe malnutrition, pressure injuries, acute kidney injury, delirium—lead to underclassification of patient clinical complexity.
- Patients with unrecognized complexity stay longer than necessary and face a higher likelihood of readmission.
- Health systems forfeit up to $15M annually in reimbursement, while mortality and length of stay O:E ratios worsen due to understated patient severity.
Current CDI processes are a retrospective scavenger hunt, capturing coding only where the clinical care was already provided. As a result, many conditions remain unrecognized and untreated, leading to missed documentation and reimbursement.
Severe malnutrition demonstrates how underrecognized clinical complexity drives both worse outcomes and lost reimbursement. Patients with severe malnutrition typically remain hospitalized two additional days and face twice the risk of readmission. Yet this chronic—and highly intervenable—condition frequently gets overlooked in the hospital as busy care teams focus on the acute reasons for admission. When severe malnutrition goes undocumented, hospitals forfeit an average of $10,000 per patient in reimbursement.
A Suite of Solutions Built to Fix the Root Cause
Clinicians are already drowning in alerts. They need the below-license, administrative work automated for them, so they can focus on patient care.
The Qventus Care Gap and Coding Automation Suite is fundamentally different from traditional screening tools and CDI point solutions on the market today. While most solutions either trigger alerts when a gap is detected or retrospectively flag missing documentation, Qventus’ AI teammates proactively close care gaps by orchestrating end-to-end workflows. Fully embedded in provider EHR workflows, these assistants surface missed diagnoses early, prompt timely consults, and ensure clinical documentation is completed before care windows close. By delivering the appropriate care—not just filing documentation—health systems improve mortality and length of stay O:E performance, meet increasingly rigorous documentation standards, and reduce denials.
The result: a patient’s true medical complexity is accurately reflected in their record—enabling higher quality care, precise risk adjustment, and reimbursement that matches clinical reality.
Malnutrition Care Automation: The Suite’s First Solution
Built on Qventus’ Care Gap Assistant and Coding and Documentation Assistant, the Malnutrition Care Automation Solution uses best-in-class chart mining to identify at-risk patients in real time, capturing cases that manual screening routinely misses. It then automatically pre-populates nutrition consult orders and prompts appropriate diagnosis documentation for MCC/CC capture.
At one southern academic medical center, the solution prompted timely nutrition consults and interventions, helping patients recover faster, and generated more than $350,000 in additional reimbursements after only three months, translating to $1.4M annually.
In addition to increased reimbursement, early malnutrition care and accurate coding delivers the following benefits for health systems:
- Timely nutritional assessments and interventions to improve patient outcomes
- Accurate MCC/CC documentation driving an average of $10,000 per patient in additional reimbursement
- Improved CMS Malnutrition Care Score performance, directly impacting public ratings
- Strengthens performance on CMS quality measures, including the Malnutrition Care Score requirement, and improves O:E mortality and length of stay
“Hospitals don’t need another audit tool, more CDI resources, or another AI point solution firing alerts at overburdened providers. They need proactive identification and closure of care and coding gaps earlier—for every patient, every care plan, every shift. Qventus automates that entire workflow: surfacing at-risk patients before conditions escalate, orchestrating the right interventions at the right moment, and ensuring complex diagnoses are accurately documented. The result is better patient care, less below-license work for nurses and dietitians, and reimbursement that reflects clinical complexity.” — Jason Cohen, MD, Chief Medical Officer for Inpatient, Qventus
Automated Care Operations for the Entire Enterprise
What makes the Care Gap and Coding Automation Suite possible is the Qventus platform: a decade-plus investment in deep, bidirectional EHR integrations, proven AI Operational Assistants, and end-to-end workflow orchestrations that span care settings. As opposed to AI point solutions that require resource-intensive implementations and lengthy contracting, Qventus clients benefit from a unified platform, guaranteed ROI, and AI teammates that work together across complex, multi-step workflows—while maintaining same-store footprint.
“Most AI solutions in healthcare automate the detection of a problem and stop there. We automate detection, intervention, documentation, and coding proactively and inside the workflows clinicians already use. This latest launch proves our platform’s ability to rapidly build, deploy, and generate ROI for new solutions at a pace our clients have never seen before. In a world where operationalizing AI in existing workflows is harder than ever, Qventus is doing it at scale—and the results speak for themselves.” — Mudit Garg, Co-founder and CEO, Qventus
About Qventus
Qventus uses AI to intelligently automate operations across care settings to help health systems secure the margins needed to achieve their mission of delivering exceptional care to patients in their communities. Leveraged by more than 150 hospital facilities, Qventus’ enterprise platform and AI solution suite reduce the administrative burden, identify potential issues upstream, surface suggested interventions, and actually take action to solve problems for busy healthcare staff—a collective system of action that sits on top of a hospital’s enterprise systems of record. Qventus unlocks best-in-industry ROI by driving strategic surgical growth, creating capacity, and reducing costs, all while delivering powerful insights to help solve long standing operational challenges once and for all. 100% of clients say they consider Qventus part of their long term strategy.
