Audit-Relevant Documentation Completion
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Below Target Range (≥ 70%)
Rate of initial encounter documentation fields populated.
CCX Audit Recoupment Risk Detection Layer identifies documentation inconsistencies across systems that create Audit Recoupment Exposure. It does not replace or modify existing systems. It reconstructs audit-ready outputs from existing cross-system documentation signals.
Audit Recoupment Exposure Overview
Audit Defensibility: Moderate
Primary Constraint: Audit Recoupment Exposure (58.2% Completion)
Secondary Constraint: Inconsistent Documentation Across Systems
Suggested Focus
Prioritize audit risk reduction in mid-tier nodes (0.58–0.75 range) where documentation inconsistency is highest.
Cross-System Audit Recoupment Exposure Mapping
Reflects how inconsistencies in documentation and referral records may create Audit Recoupment Exposure across systems.
Referral Documentation Integrity
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Below Target Range (≥ 70%)
Relationship between referral action and documentation evidence.
Audit Defensibility Score
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Below Target Range (≥ 70%)
Weighted aggregate of audit defensibility signals.
Network Risk Interpretation
Primary observation:
Variability in documentation completeness increases Audit Recoupment Exposure across records.
Secondary observation:
Node-level variability indicates uneven audit defensibility across the network.
Risk implication:
Mid-range nodes (0.58–0.75) represent the highest concentration of Audit Recoupment Exposure.
Audit Risk Distribution View
Audit Risk Distribution View
Primary Domain: Housing
Housing
Nutrition
Transportation
Care Access
Reflects how needs and service activity are distributed across domains. This represents aggregated system outputs, not a standalone dataset.
CCX Audit Recoupment Risk Detection Layer (Model) Deterministic audit recoupment risk modeling layer. Not a billing or clinical decision-making.
Audit Recoupment Exposure Model
Rationale:
Documentation variability may increase Audit Recoupment Exposure and reduce consistency of compliant reporting outputs.
Decision Use:
These estimates support evaluation of documentation defensibility and Audit Recoupment Exposure across the network.
Modeled estimates based on healthcare audit and documentation burden benchmarks. Not a financial or reimbursement tool.
VIEW MODEL ASSUMPTIONS & LOGIC →
Infrastructure Assumptions
Reflects 15–30m manual screening baselines vs. structured data reuse. Admin overhead calibrated to early-stage SCN pilot benchmarks.[1]
Research Benchmarks
Aligned with AMIA 25x5 documentation burden reduction goals and SCN navigator time-and-motion studies (~38% overhead in fragmented care nodes).[2]
Audit Recoupment Risk Detection
Year 1–2 expectations for NY SCNs. Implementation is eligible as infrastructure capacity-building investment. Full Logic →
- [1] SCN Performance Baselines & Administrative Friction Parameters (2024–2025 Initial Operations).
- [2] AMIA 25x5 Task Force on Reducing Documentation Burden (American Medical Informatics Association). Models applied to non-clinical social care intervention tracking.
Audit Recoupment Exposure Profile
Audit Touchpoint Profile — 125 Nodes
Distribution Summary
Nodes represent documentation points across the network.
High Defensibility: 18%
Moderate Defensibility: 62%
High Audit Recoupment Exposure: 20%
AWAITING NODE SELECTION...
System Signals
Compliance Export Layer
Provides structured export of aligned records for reporting and compliance use.
| Node ID | Documentation Completion | Audit Defensibility | Audit Recoupment Exposure Score | Category |
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