Retrospective Risk Adjustment
A best in class Retrospective Program with over 31,900 triggers in our Rules Engine
As one of the early pioneers, Leprechaun has been providing full service turnkey Retrospective since 2005. The strength of the Leprechaun Retrospective product is the sophisticated system developed for identifying, quantifying and ranking medical records. Our predictive models for chart selection algorithms rank as one of the best in the industry, utilizing four rule categories to generate over 31,900 trigger combinations of ICD9s, CPT, HCPCS and NDC codes. Because of the power of our rules engine, Leprechaun achieves exceptional financial performance, while still maintaining a minimum of 95% code accuracy. In 2008, our clients experienced an exceptional average ROI of 4.6.
As a full service turnkey product, our Retrospective includes all the processes needed to implement a best-in-class retrospective service. Our service includes identifying the most likely charts to have incomplete, inaccurate and missing codes, retrieving and scanning charts at the provider office, reviewing scanned charts with our expert trained nurse reviewers, providing numerous financial, provider and member analysis reports, performing the RAPS process and sending a RAPS file to the health plan to submit to CMS.
The Leprechaun Difference:
- A complete turnkey full service workflow operation
- High yield performance ROI of > 4.6 and still maintains a minimum 95% accuracy rate
- Over 31,900 triggers for identifying potential under-diagnosed or incorrect diagnosis for four rule categories; persistence, pharmacy, code specificity and code interaction
- An audit defensible solution with scanned charts immediately available
For more information, please download our Product Brief which provides details of features and benefits and a description of our Retrospective Services
