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Review AI compliance findings

warning

RehabAlpha is still under active development. It is not yet HIPAA compliant and should only be used with dummy data.

After a saved evaluation, re-evaluation, progress report, treatment, or discharge meets the document requirements for signing, RehabAlpha reviews it in the background. The AI compliance review section highlights concerns that could contribute to an audit question or claim denial. You can continue working while the review runs; you do not need to sign the document first.

The section stays hidden until the signing checklist is complete and the document's date and time permit signing. Cancelled treatments, no-shows, refusals, and other resolutions with no delivered services do not receive reviews. Completed and partially completed treatments qualify; Unable to Complete - Acute Medical Event qualifies only when services have recorded minutes.

Read the findings​

  1. Open the saved clinical document in view mode.
  2. Select AI compliance review in the sidebar, or scroll to its section between Metadata and Signatures.
  3. Read the risk level and the bulleted concerns beneath it. Each concern identifies something to clarify or correct. If there are no concerns, the section says No concerns identified.
  4. Check the review time and payor beneath the findings.

The review includes up to five concerns, with the most important first. When missing information affects a concern, the concern explains that uncertainty.

The risk level describes the evidence reviewed:

  • Low risk: No material documentation concern was identified in the available evidence.
  • Medium risk: A concern or uncertainty needs clarification.
  • High risk: The available evidence supports a substantial documentation concern.

Use your clinical and billing judgment when reviewing the findings. The review does not determine coverage or reimbursement, and a low-risk result does not guarantee payment.

To address a finding, click Edit, update the documentation, and save. The new version is reviewed automatically. The section updates when the review is ready.

Understand the section status​

  • Not reviewed yet means a saved document does not have a review result yet.
  • Review queued means the document is waiting for background processing.
  • Review in progress means a review is running.
  • Document changed. Awaiting an updated review means the displayed findings are out of date.
  • Previous review identifies retained findings while an update is pending, the document has changed, or the latest review or connection failed. Treat those findings as previous advice.
  • Review could not be completed means the review failed. Temporary failures retry automatically. Some failures require updated evidence before another AI call; the section identifies those cases. If the essential documentation is too large for an AI review, the section asks you to review it manually.
  • Review updates are unavailable means the section cannot receive updates. Reload the page to reconnect.

Reviewed shows how long ago the displayed findings were generated, the date and time, and the payor used. If the evidence has not changed, RehabAlpha reuses the findings without another AI call. The displayed review time stays the same.

Understand what is reviewed​

The review considers documentation quality, justification for skilled therapy, internal contradictions, diagnoses, treatment plans, procedure codes, minutes, and consistency with related notes.

For every payor, a service item with more than zero minutes and blank notes produces a concern and at least Medium risk. This applies to timed and untimed codes. Add notes to the service item describing what was performed; general document notes or a prior treatment plan do not fill that field.

Related evidence comes from the same admission. Depending on the document, it can include the evaluation, re-evaluations, a prior progress report, recent treatments, and same-day documentation from other therapy cases. Same-day notes do not establish which sessions were paired for co-treatment; a review should describe that uncertainty.

History is limited so the review can run within its size limits. The target document, applicable payor guidance, and authoritative treatment plan take priority. Missing supporting information or omitted history may limit what the review can identify.

The primary payor is selected for the document's date, discipline, and case. For a progress report, RehabAlpha uses the reporting period's start date. Guidance for a different payor on a related note is not included.

Add payor-specific guidance​

With permission to update payors:

  1. Open Payors and select the payor.
  2. Open Details and click Edit.
  3. Under Payor rules, enter AI compliance guidance.
  4. Describe the payor's documentation requirements, such as required justification or permitted treatment-plan styles.
  5. Click Save.

Use requirements from the payor's policy. Leave patient-specific details out of this field. See Set up a payor.

You should know​

  • Reviews run after an eligible saved document changes.
  • If an edit makes a document ineligible for signing, its review is removed and the section disappears. RehabAlpha checks eligibility again after relevant changes, including changes to required clinical fields or billing context. Future-dated documents can become eligible when their signing date arrives without another save.
  • Changes to relevant supporting documentation, payor guidance, or billing context queue affected reviews for another check, including reviews in closed cases. Background updates can take several minutes, and larger queues can take longer.
  • The reviewed payor label belongs to the displayed findings. It may differ from the document's current payor while a new review is pending.
  • Signing alone does not create a new clinical document version or start a new review.
  • Anyone who can view the clinical document can view its review. The section is not shown in edit mode, printouts, or downloaded PDFs.