Today, many complex conditions in hospitals are undertriaged and undertreated. CDI teams audit charts 24–48 hours after care—long after the window for meaningful intervention has closed. 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 clinical care was already provided. This still leaves a multitude of conditions that go untreated, and therefore are not documented or reimbursed.
A Suite Built to Fix the Root Cause
Today we’re launching 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.
Where screening tools and CDI point solutions identify a gap and fire an alert, our AI teammates proactively close care gaps by orchestrating end-to-end care and coding. Fully embedded in provider EHR workflows, our assistants surface missed diagnoses upstream, prompt timely consults, and complete clinical documentation before care windows close.
By delivering the right care and not just filing documentation, hospitals improve O:E mortality and length of stay, while adhering to increasingly stringent documentation standards and reducing 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
The first solution in the suite, Malnutrition Care Automation, is live today. Built on our Care Gap Assistant and Coding and Documentation Assistant, the 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.
Malnutrition doesn’t present as an acute condition, so even diligent care teams struggle to consistently identify, address, and document it. Patients can stay hospitalized two additional days and face twice the readmission risk. Hospitals also lose an average of $10,000 per patient in legitimate reimbursement when malnutrition goes undocumented.
For Staff: Automated workflows mean physicians can focus on patient care instead of documentation requirements, and nurses and dietitians aren’t spending time on manual chart review and below-license work.
For the Bottom Line: MCC/CC (Major Complication and Comorbidity/Complication and Comorbidity) documentation drives, on average, an additional $10,000 per patient in reimbursement. The solution also improves hospital performance on CMS quality measures, including the Malnutrition Care Score requirement, which directly impact public ratings.
A southern academic medical center saw impressive results in the first three months:
- More than $350,000 in additional reimbursements ($1.4M annualized)
- Timely nutritional assessments, consults 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
“Hospitals don’t need another audit tool, more CDI resources, or another AI point solution firing alerts at overburdened providers,” said Jason Cohen, MD, Chief Medical Officer for Inpatient at Qventus. “They need proactive identification and closure of care and coding gaps earlier—for every patient, every care plan, every shift.”
Platform-Powered Speed
What made these results possible in such a short timeframe? The Qventus platform.
The Care Gap and Coding Automation Suite leverages Qventus’ decade-plus investment in deep, bidirectional EHR integrations, proven AI Operational Assistants, and end-to-end workflow orchestrations that span care settings. Unlike AI point solutions that require resource-intensive implementations and lengthy contracting, our clients benefit from a unified platform, guaranteed ROI, and AI teammates that work together across complex, multi-step workflows—while maintaining same-store footprints.
We were able to build, deploy, and generate ROI in mere months—which is significant in a world where operationalizing AI in existing workflows is exponentially harder than it’s ever been.
“Most AI solutions in healthcare automate the detection of a problem and stop there,” said Mudit Garg, Co-founder and CEO of Qventus. “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..”
What’s Next
Malnutrition Care Automation is the first of several planned care gap closure and coding solutions. It demonstrates exactly what our platform investments enable: rapid development and deployment of high-ROI solutions that solve critical operational challenges health systems have faced for years.
Learn more about the Care Gap and Coding Automation Suite here.