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Reveleer Launches Risk Adjustment 2.0: New AI-Driven Coding Capabilities for Health Plans and Risk-Bearing Providers

Reveleer, a healthcare technology company using intelligent automation to empower data driven healthcare for payers in all lines of business, announced the launch of Reveleer for Risk 2.0. (Risk 2.0), the revolutionary and only end-to-end cloud-based platform for clinical data acquisition and coding for health plans nationwide. Proprietary Artificial Intelligence-driven capabilities allow health plans to confidently plan and execute risk adjustment programs with critical support to automate the collection, analysis, review, and submission of risk adjustment data.

AI in healthcare is increasingly critical to enabling quality, predictive patient care, and better outcomes. A Modern Healthcare article reported on the future of AI, noting, “There is great promise associated with the use of artificial intelligence in healthcare.” The article continued, “AI …will help alleviate costs by driving efficiencies at various levels. AI can help achieve this by making care overall less time consuming, and even more instantaneous.” As health plans and providers face increasing pressure to do more with less, Risk 2.0 provides a path to transformation.

“For years, AI has under-delivered on increased productivity and value claims,” said Jay Ackerman, CEO, and President, of Reveleer. “Reveleer is shifting the paradigm. Instead of replacing human intelligence, AI’s role today should be to assist coding teams with improved accuracy and productivity. Risk 2.0 functions like a virtual team member who reliably evaluates complex clinical data and rule sets, allowing coders to focus on efficiently validating and submitting HCCs. Accurate code capture appropriately delivers higher reimbursement to plans for patient care, an incentive to reinvest in preventive health for improved well-being across our communities ultimately fulfilling the mission of value-based care.”

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The platform’s AI-driven evidence validation engine processes approximately 500 million pages of data annually, appropriately measuring quality and cost performance. The combination of proprietary technologies, including natural language processing (NLP), optical character recognition (OCR), and machine learning models, automates chart verification, validates administrative claims data, and identifies net-new encounters, diagnoses, and HCCs. AI-assisted coding via broad match technology and Confidence Scoring eliminates false positives and delivers 98% HCC discovery accuracy on first pass. Medical record data is then returned to coders to further assist with faster, more accurate reviews, with up to 45% improvement in productivity. Customizable AI-driven coding guidelines enable health plans to incorporate their own plan-specific rule sets within the platform.

Risk Adjustment 2.0 incorporates several workflow enhancements to improve the user experience. These include Rapid Scan Thumbnails, which provide a comprehensive view of relevant medical records, color-coded for easy identification of clinical evidence types and protected health information (PHI). Reviewers can rapidly sort through only those pages with evidence, reducing the number of pages that must be manually read. Screen Sync enables simultaneous split-screen medical record review and data entry, dramatically reducing the need to scroll. Together, these enhanced capabilities deliver an elegant and efficient coding experience, helping optimize productivity and accuracy.

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[To share your insights with us, please write to sghosh@martechseries.com]

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