If you work in PACE, you know risk adjustment can feel like a moving target. Between evolving CMS models, changing submission requirements, and the never-ending quest for accurate documentation, it’s a lot to keep up with.
That’s why we built the Intus Revenue Integrity System (IRIS), a risk adjustment solution designed specifically for value-based care programs like PACE. IRIS obscures the complexity of risk adjustment, helping teams improve coding accuracy, reduce compliance risk, and capture the full reimbursement they’ve earned.
The best part? It was built to streamline Provider and IDT workflows, helping them focus on care.
Why IRIS?
For too long, risk adjustment has been a patchwork of retrospective audits, manual chart reviews, and endless spreadsheets. IRIS changes that.
IRIS delivers real-time, actionable insights before and after each encounter, making risk adjustment a proactive part of care delivery. Think of it as moving from playing catch-up to staying two steps ahead.
How IRIS Works
Malissa Bolish, IntusCare Director of Risk Adjustment, did an outstanding overview of IRIS during our recent v22 to v28 transition webinar:
Check out the full webinar recap and recording.
Here’s what sets IRIS apart:
- Data aggregation that delivers
Pulls in clinical and eligibility data from your EMR and other sources. No more hunting and reconciling. - Natural language processing (NLP)
Reads between the lines in documentation to identify unaddressed or predictive conditions. - Pre-encounter prep (PEP)
Our onshore risk adjustment consultants review NLP findings and surface relevant conditions directly to providers before the visit. - Purpose-built dashboards
Providers see all relevant HCC and RxHCC diagnoses in one place. Clear, concise, and right where they need it. - Concurrent reviews
Post-assessment, consultants validate coding and documentation to ensure everything is accurate, compliant, and complete. - CMS submission support
Each month, IRIS generates submission files that align with CMS requirements (RAPS and EDS) and submits them to your TPA partner right on schedule. - Real-time analytics
Forecast revenue, reconcile monthly payments, and spot errors before they become problems. - Proactive audits + education
Identify issues early and use trends to guide provider training, rather than scrambling after an audit.
IRIS in action at Great Lakes PACE
Don’t just take our word for it. See how IRIS is driving early results with Great Lakes PACE.
IRIS FAQs
How does IRIS capture all relevant conditions?
NLP scans documentation, consultants validate the findings, and providers review recommendations before assessments. Nothing slips through the cracks.
How does IRIS streamline CMS submissions?
We generate the files monthly for your TPA, aligned to CMS formats and timelines, so you don’t risk delays.
Does it only work with CareHub?
Nope. While IRIS + CareHub is the dream team (more on this soon), it works with.
What about compliance?
Every step emphasizes accuracy and defensible documentation. Ethical coding is baked in.
How’s this different from retrospective audits?
Concurrent coding and PEPs capture revenue opportunities in real-time on 100% of census, eliminating the need for retro reviews.
What does implementation look like?
Training, 1:1 coaching, and ongoing support are included. We involve your full team, not just providers, because risk adjustment success is a team sport.
Will IRIS keep up with CMS changes (like v22 → v28)?
Absolutely. IRIS is regularly updated to reflect CMS model changes, so your reimbursement stays accurate through transitions. Check out our recap of the recent PACE risk adjustment webinar here to learn more.
The bottom line
Risk adjustment is too important to leave to chance. IRIS gives PACE organizations the confidence that every diagnosis is accurate, compliant, and supported, while making life easier for providers and coders along the way.
Ready to take a tour around IRIS?
