Running a RADV audit in-house: How Lumeris cut chart review time in half

The solution: The Health Language Coder Workbench

Building on an established relationship with Wolters Kluwer and an internal team already proficient with the Coder Workbench, Lumeris selected the Health Language Coder Workbench and its Regulatory Audit Module to power the response.

The module met the team's core requirements: fast configuration with no long implementation timeline, throughput at volume without manual workarounds, and a single source of truth for coders, QA, compliance, and leadership. Here's how it worked:

• Real-time diagnosis capture: As records were coded, the system captured diagnosis-level detail and performed hierarchy comparisons, so coders could immediately see whether each diagnosis was a match, a higher, a lower, or an add.
• Confidence scoring and color-coded validation: Clear signals guided submission decisions, helping coders at different experience levels arrive at consistent, defensible choices.
• Interactive chart-and-diagnosis linking: Reviewers could click directly back into the exact chart and diagnosis instead of hunting through files.

The result: A defensible, repeatable playbook for in-house RADV audit response

Lumeris finished the PY 2019 RADV with measurable operational gains and a stronger posture for the audits ahead. Managing 255 HCCs across 35 enrollees and 512 targeted records, the team cut chart review time in half, a difference felt most on records running several hundred pages, like multi-admit inpatient charts.

Essence Healthcare, PY 2019 RADV by the numbers

• 35 enrollees in audit scope
• 255 HCCs reviewed
• 50% reduction in chart review time
• 20+ hours saved on reporting and governance
• 512 records retrieved and managed

Beyond the numbers, the module created a structured record of every retrieval effort, coding decision, QA outcome, and submission, staged in one place. That positions Lumeris to readily navigate appeals and post-audit inquiries without recreating work months later. 

Get the full story

Download the complete case study to see exactly how Lumeris built its in-house RADV playbook, the decisions that shaped its response, and how your team can prepare for the audits to come. Want to go deeper? Watch our on-demand webinar with Lumeris, Master the RADV audit process with proven strategies, for expert guidance on navigating every phase of the RADV audit.