Chart Review & Audit (Retrospective Solutions) are a Pivotal part of claims payment uprightness

Retrospective reviews – It is directly reported to CMS without additional health care provider involvement. It is a Popular approach with insurance organizations, It eliminates the need to engage providers and request additional documentation or clarifications. However, they are relatively constrained. 

Risk Adjustment Coding Compliance Pro Solution

Whom do we Cater

A comprehensive retrospective risk adjustment solution orchestrates the traditional chart review process by shifting the focus from charts’ volume to precision targeting charts. The result is minor chart retrieval requests, which decrease provider erosion and increase the productivity of each review. Here, we cater to the Payers, Coding service companies and Healthcare IT service providers

For Health plans to perform risk adjustment  for Audits and Chart reviews, their process may be Costly, Inefficient and Wasteful in many ways:

  • Wasted resources and expenses when managing multiple vendors
  • Unnecessary provider abrasion caused by retrieving unproductive charts
  • Disrupting providers with manual chart retrieval and review
  • Manual coding can miss potential unreported diagnosis codes and leave coding accuracy incomplete

Improve Accuracy Efficiency & Productivity with RAAPID

We will help you with:

Run AI-enhanced analytics

Retrieve & Review charts

HHS claims verification

Get rid of multiple vendors

RAAPIDs’ Retrospective Workflow 

We use NLP Powered AI-Enabled Risk adjustment solution to optimize the retrospective risk adjustment process. It can be configured to automatically optimize HCC Risk Adjustment Coding & Chart Retrieval Solutions which do not support unreported diagnosis codes. RAAPID’s AI-enabled Risk adjustment solution maximize the productivity of the retrospective risk adjustment process by Prioritizing charts with precision to support unstructured diagnosis codes by Identifying the retrieval modality, and Predicting & prioritizing disease conditions possibly supported in the chart for coder review

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Perspective and Retrospective Review Mobile

Retrospective Solution  for Chart review 

RAAPID’s AI-enabled analytics modernizes the traditional chart review process by shifting the focus from the volume of charts targeted to the precision targeting of charts. The result is fewer chart retrieval requests, which lowers provider abrasion and increases the efficiency of each review.

Retrospective reviews are directly reported to CMS without additional health care providers’ involvement. It eliminates the need to engage providers and request additional documentation or clarifications. However, they are relatively constrained. Medical Coding Service Companies can benefit most from RAAPID’s Retrospective chart review solution. A majority of Insurance Companies outsource their Risk Adjustment work to medical coding companies. With RAAPID’s AI-driven solutions, the health chart reviews are faster smarter, and easier – impacting directing on Revenue cycle and data accuracy.

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Key Impacts on Medical coders

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Key Impacts for mobile

Retrospective Solutions for Audits

A proper, legally viable, and tech-driven risk score calculation is pivotal for healthcare organizations, insurance providers, coders, and, of course, patients. CMS is going to increase its auditing of data submitted by Health plans to optimize the RA claims (as per the recommendations from OIG audits) . CMS outsources auditing services to vendors

RAAPID’s HCC Auditor streamlines the code review process with the industry-leading AI coding platform that identifies source encounter notes for submitted HCCs. This approach helps audit reviewers focus their efforts on investigating the subset of codes that are most likely to be unsupported.

Retrospective Solutions for Audits Payers Desktop
Retrospective Solutions for Audits Payers Mobile

Retrospective Health Plans Auditing

The retrospective audit is generally based on a review of records of discharged patients. This may provide information that is more representative of day-to-day practice, but it is more difficult to obtain complete data on every subject in the sample. It is a cost containment mechanism that health insurers use to determine whether overpayments on claims have been made to a particular physician practice. 

To get a protective shield from CMS’s penalty, Payers outsource this service to their coding

Retrospective Health Plans Auditing

Why partner with RAAPID

We strongly believe the customers should have access to their submitted data at all times. We not only offer standard dashboards, but are also open to configure additional graphs and reports based on their unique requirements or requested KPI additions Health systems and Insurance companies use RAAPID’s NLP Powered AI Driven solutions to understand the data, navigate to the accurate risk score and the compliant codes, and thrive in the ever-changing value-based care environment.

Why partner with RAAPID Desktop
Why partner with RAAPID Mobile