Payer-Focused Solution

Transform Retrospective Audits into Strategic Revenue Opportunities

Precise Health Risk Compass™ Retro360 transforms retrospective risk adjustment from a reactive compliance exercise into a proactive revenue optimization strategy. Medicare Advantage organizations gain the intelligence needed to make informed decisions about where to invest audit resources for maximum financial return while maintaining regulatory compliance.

By leveraging historical claims and audit data with advanced RADV analytics, organizations achieve greater visibility into revenue potential, reduce audit-related costs, and build confidence in their audit readiness—all while optimizing the allocation of valuable audit resources.

Maximize Revenue Recovery

Identify and capture missed revenue opportunities through intelligent audit targeting and strategic planning

Reduce Audit Risk Exposure

Strengthen RADV audit defense with comprehensive documentation validation and compliance tracking

Optimize Resource Efficiency

Allocate audit resources strategically based on revenue potential and risk-adjusted ROI analysis

Key Capabilities

Core Platform Capabilities for Audit Excellence

Powerful capabilities that enable Medicare Advantage organizations to develop sophisticated audit strategies, optimize resource allocation, and drive measurable improvements in revenue capture with retrospective risk adjustment analytics.

Retrospective Audit Strategy Development

Build comprehensive audit strategies based on population risk analysis, historical performance, and revenue optimization goals.

Strategic Audit Planning & Prioritization

Plan and prioritize retrospective chart reviews with data-driven member and chart selection for maximum revenue impact.

Revenue Forecasting & Risk Modeling

Forecast year-end revenue potential using advanced risk modeling and track performance against projections to identify capture opportunities.

Continuous Performance Monitoring

Monitor audit performance, revenue capture trends, and compliance metrics in real-time throughout the audit cycle.

Delta & Variance Analysis

Identify variance between projected and actual revenue capture to refine audit strategies and improve targeting.

Audit Resource Optimization

Allocate audit resources efficiently based on revenue potential, risk levels, and historical audit performance data.

Platform Features

Advanced Tools & Analytics for Retrospective Audit Management

Specific platform features and tools that power your retrospective audit workflows—from automated audit enablement analytics to comprehensive reporting.

Population Risk Modeling & Forecasting

Predicts year-end risk potential using advanced risk modeling and tracks performance against revenue projections.

Post-Audit Opportunity Assessment

Reviews audit outcomes to identify patterns and optimize future audit strategies.

Audit Workflow Automation

Streamlines retrospective audit processes with automated chart prioritization, task assignment, and progress tracking.

Member-Level Risk Profiling

Highlights documentation gaps and coding opportunities across member populations.

CMS Submission Optimization

Delivers clear, data-driven recommendations to improve submission accuracy and compliance.

Revenue Trend Tracking

Monitors fluctuations in risk adjustment performance and their underlying causes.

High-Value Chart Flagging

Spotlights charts requiring immediate audit attention for maximum revenue impact.

RAF Score Optimization Guidance

Matches missed opportunities with documentation gaps to improve revenue capture.

Real-Time Performance Dashboards

Visual analytics dashboards provide instant visibility into audit progress and performance metrics.

Strategic Planning

Data-Driven Retrospective Audit Strategy & Planning

Transform retrospective audit management with comprehensive strategy development and intelligent planning powered by medicare Advantage risk analytics.

Chart-Specific Audit Prioritization

Aligns audit resources with charts showing the highest revenue recovery potential.

High-Impact Diagnosis Focus

Directs attention to diagnosis codes that affect compliance, quality, and financial performance.

Targeted Revenue Initiatives

Avoids audit overload by eliminating low-value charts, reducing costs while improving revenue capture.

Revenue & Performance Monitoring

Continuous Revenue Forecasting & Performance Monitoring

Maintain year-round visibility into revenue capture performance with continuous monitoring and forecasting updates.

Captured & Uncaptured Revenue Insights

  • Gain clarity at the provider, specialty, and member level on risk adjustment performance
  • Track revenue capture trends over time
  • Identify systematic documentation gaps

Diagnosis & HCC-Based Revenue Tracking

  • Compare performance across top revenue-generating diagnosis codes
  • Analyze HCC category capture rates
  • Benchmark against industry standards

Revenue Recovery Planning

  • Evaluate when and how remaining revenue potential can be captured
  • Plan resource allocation before CMS deadlines
  • Maximize end-of-year revenue optimization
Proven Results

Measurable Impact with Retro360

With focused implementation, Retro360 users experience transformative results in revenue capture and audit performance.

360°
Comprehensive Audit Visibility

Complete visibility into retrospective audit strategy, planning, forecasting, and performance monitoring

95%
Forecasting Accuracy

Achieve highly accurate revenue projections with advanced risk modeling and continuous tracking

5★
Stronger CMS Compliance

Maintain documentation integrity that withstands RADV and other regulatory audits

100%
Enhanced Audit Confidence

Equip audit teams with precision-level insights based on data-driven revenue analytics

Get Started with Retro360 Today

Schedule a personalized demo to see how Precise Health Risk Compass™ Retro360 fits into your organization's retrospective analytics strategy.

Schedule Your Retro360 Demo