Accelerating clinical coding precision with AI
Business challenge
A large payer organization with more than one million medical charts to manage annually struggled to scale its risk adjustment coding operation as its Medicare Advantage business grew.
The payer worried that, without advanced technology, it would be unable to manage medical chart volumes in a cost-effective way, risking inaccurate Risk Adjustment Factor (RAF) scores and lost reimbursements.
AI-powered coding with Reveleer's Evidence Validation Engine
To manage more than 1 million charts within strict retrospective risk adjustment timelines, the payer organization turned to Reveleer’s clinical coding solution powered by our proprietary Evidence Validation Engine, EVE™.
EVE analyzed clinical data and pinpointed the most relevant evidence for each case, presenting this evidence to human coders for review and ensuring the capture of all relevant HCCs.
The payer was then able to drive increased efficiency by tracking productivity, monitoring work completion traits, and drilling down into individual chase-level tasks.
Sharing data across an expanded program
With EVE™, the payer’s coding teams have been able to collaborate seamlessly, gain deeper visibility into key performance metrics, and facilitate data-driven decision-making for future risk adjustment cycles. By fostering collaboration and shared data insights, they can refine their value-based care approach andoptimize member health management. As a result, the healthcare organization has experienced a 40% increase in the value per chart and 30% more efficient workflows.
Next step: scale clinical coding operations with AI
The payer organization recognized the value of Reveleer's platform beyond coding productivity. The impressive speed and return on investment have led the plan to expand Reveleer's role across prospective risk adjustment and quality improvement initiatives. This expansion unlocks the true power of Reveleer's value-based care platform: integrating functions, connecting teams, and automating workflows across diverse risk adjustment and quality projects.
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