Risk Adjustment Solution
A smarter approach to risk adjustment in healthcare
From lightning-speed retrieval to simplified submissions, Reveleer’s comprehensive Risk Adjustment software improves performance across Medicare Advantage, ACA, and Medicaid health plans.
Using AI and intelligent automation, Reveleer quickly retrieves and matches medical data to the right patient, accelerating record collection by up to 80%.
EVE™, Reveleer’s AI-powered assistant, delivers up to 99% accuracy in identifying and mapping potential missed diagnoses to the correct HCCs.
Health plans and providers trust Reveleer to manage CMS and RADV-IVA submissions—accurately and on time.
Reveleer’s Risk Adjustment software enhances health plan efficiency while improving HCC capture and RAF accuracy. By integrating AI into clinical workflows and delivering fast and precise insights, customers see a 3X return on investment within a year.
A large regional health plan needed to scale its risk adjustment programming as its Medicare Advantage business grew. It used Reveleer’s Risk Adjustment suite to help code 1.2 million charts in 4 months, tripling its coding speed.
To quickly analyze a high volume of charts, the health plan leveraged Reveleer’s Evidence Validation Engine (EVE™) to pinpoint the most relevant evidence for each case.
EVE™ assisted the plan’s coders by validating existing diagnoses and uncovering potential missed conditions, significantly increasing the value of each chart.
Reveleer’s Risk Adjustment suite facilitated collaboration among the plan’s coding teams and saved countless hours of time previously spent manually reviewing each chart.
Leverage claims and encounter data to predict future revenue adjustments. Reveleer surfaces suspected conditions and missed opportunities, helping teams focus on high-impact members and improve reimbursement accuracy.
Monitor coding accuracy and identify potential gaps with real-time dashboards and analytics. Get full visibility into project progress and risk impact to support faster, data-driven decisions.
Streamline coding workflows with chase prioritization, suppression, quick clinical review, and one-click validation—reducing errors and boosting RAF accuracy and compliance.
For health plans and providers, effective retrospective risk adjustment is key to success in value-based care. Accurate, efficient programs support fair reimbursement, high-quality care, and financial sustainability. With AI, organizations can drive targeted HCC optimization and improve financial, clinical, and compliance outcomes.
Reveleer extracts 96K+ pages of structured and unstructured clinical data hourly from disparate systems to deliver real-time insights for value-based care.
Reveleer's AI-powered, Evidence Validation Engine, EVE, guides abstractors to member insights linked seamlessly to clinical source documentation to optimize the clinical review process.
Patient Index is a consolidated collection of linked patient data mined from multiple sources and systems for a unified view of patient care across member management, risk adjustment, and quality improvement.
Risk adjustment is a method used to predict healthcare costs and allocate financial resources based on the health status of individual patients in value-based care. Each health plan member is assigned a risk score based on a number of clinical data points. Risk adjustment is often conducted annually looking at the previous year’s data (also called retrospective risk adjustment) to determine the overall health status and associated costs of a patient population.
To conduct risk adjustment, health plans must collect and integrate patient data from a variety of sources which are often fragmented and formatted inconsistently. The plan must then use the data to assign each member a risk score based on the estimated cost of that patient’s care.
Medicare Advantage plans use risk adjustment to determine their monthly capitation payments from CMS.
HCCs are groupings of medical diagnoses that share similar cost patterns. In the CMS risk adjustment model, HCCs are used in determining member risk scores.
Yes, the entire Reveleer platform is compliant with CMS, HIPAA, and other regulatory bodies. We designed our platform workflows to align with CMS requirements, and our team keeps a close eye on the ever-evolving regulatory landscape to ensure processes from data acquisition to CMS submissions meet the highest regulatory standards.
In addition to our powerful Risk Adjustment suite, Reveleer offers a single platform for value-based care that incorporates Quality Improvement, Clinical Intelligence, and health plan Member Management technology suites.
Learn how AI-powered risk adjustment technology can make all the difference in increasing speed and accuracy.
.avif)
OIG is auditing more health plans for Medicare and Medicaid Overpayments at a time when payers are already concerned about lower reimbursements.
Discover five ways AI solutions can produce a significant ROI and help plans and providers achieve their value-based care goals.
Learn how clinical engagement enhances risk adjustment by improving coding accuracy, financial predictability, and patient outcomes.
%20-%20Standing.avif)
