Case Study

AI to Accelerate Clinical Coding

July 31, 2024
By , ,

How a large state Blue Cross plan coded a year’s worth of medical records in four months with Reveleer

Business Challenge

A large state Blue Cross Blue Shield (BCBS) Plan 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 health plan worried that, without technology, they would be unable to manage medical chart volumes in a cost-effective way, risking inaccurate Risk Adjustment Factor (RAF) scores, and lost reimbursements.

Key Highlights

1.2M charts coded in 4 months

AI-assisted clinical coding

40% increase in value per chart

Solution:
AI-Powered Coding with Reveleer's Evidence Validation Engine

To manage the massive volume of more than 1 million charts within strict retrospective risk adjustment timelines, the BCBS Plan turned to Reveleer’s clinical coding solution, powered by our proprietary Evidence Validation Engine (EVE).

EVE analyzed clinical data received from providers and pinpointed the most relevant evidence for each case. EVE then presented this evidence to human coders for efficient review and validation, assigning coders in validating existing diagnoses and uncovering potential missed conditions supported by sufficient evidence. This ensured capture of all relevant HCCs, leading to more accurate RAF scores.

The health plan identified the value of Reveleer's platform beyond coding productivity. The SaaS platform empowered teams to collaborate seamlessly, leveraging built-in analytics for deeper visibility into key performance metrics. This included tracking productivity, monitoring work completion rates, and gaining insights into individual chase-level tasks. This comprehensive view facilitated data-driven decision making for future risk adjustment cycles.

Sharing Data Across an Expanded Program

The impressive speed and return on investment (ROI) las led the Blues Plan to expand Reveleer's role across prospective risk adjustment and quality improvement initiatives.

This expansion unlocks the true power of Reveleer's platform: integrating functions, connecting teams, and automating workflows across diverse risk adjustment and quality projects. This unique capability allows the Blues Plan to seamlessly share clinical data across these programs. By fostering collaboration and shared data insights, they can refine their value-based care approach and optimize member health management.

3X
increase in coding speed

40%
more value per chart realized

30%
more efficient workflows

About the author
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