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Accurate documentation of diagnoses codes is right at the center of a successful Risk Adjustment program. If this is such an essential activity, why is it so hard to get it right?

Risk Adjustment professionals know there are many factors at play, from how well the provider documents the patient encounter, how accurately the coder captures the risk adjustable information, to the ability to code all  medical records needed on time.

As a full service vendor, Reveleer assists health plans in solving the above three challenges and more – as we know, risk adjustment is not a simple task. However, this is our specialty, we are here to help and we have designed an amazing piece of software for Risk and Quality that enables you to perform outreach, retrieve, code, and audit everything on your own.



Whether you are ready for your team to execute retrieval and coding on their own, or you are engaging with a vendor, here are three key areas to focus on to get the best coding results:

1. Compliance


CMS rule changes need to be implemented and documentation needs to be adjusted following any code change.


The easiest way to accomplish compliance is to engage with a vendor that is also a partner for you and your team. A company that functions as an extension of your team, and is invested in your success. During these changing times, CMS and HHS announce new rulings and changes that need prompt implementation – your team may not be able to keep up with everything for this reason the extra support is needed. The second option is to appoint someone in your team to closely follow CMS and makes sure upcoming changes are applied. In our case, Reveleer has designated trained specialists that subscribe to CMS news, monitor CMS rules and code changes, keep up with newsletters and ensure annual rule implementations for our clients and our own processes. This supports an effective Risk Adjusment practice that remains compliant.

2. Accuracy


Codes are missed or not coded with the proper specificity.


Develop internal checkpoints and utilize tools and resources for proper review. Using Reveleer’s robust reporting, you can follow progress and the life of the chart at each step of the way. You can view work reports at real-time, and use Reveleer’s platform to review coders’ progress and charts status and compare it to your productivity measures and internal checkpoints. You can also create provider profiles in Reveleer to identify a provider group that is consistently under- or over-coding a specific condition, and keep track of follow-ups and communication efforts.

3. Completeness


There’s not enough information on the condition.


A powerful platform with built-in data entry checks can reduce errors and ensure all codes available have been captured. A complete platform such as Reveleer will provide you with two levels of overread - for you to closely follow the coding process and obtain the highest accuracy and completeness rates. 

About The Author

Reveleer is a healthcare-focused, technology-driven workflow, data, and analytics company that uses natural language processing (NLP) and artificial intelligence (AI) to empower health plans and risk-bearing providers with control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform allows plans to independently execute and manage every aspect of enrollment, provider outreach, data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services, so health plans can confidently plan and execute programs that deliver more value and improved outcomes. To learn more about Reveleer, please visit