Significantly Improve Your Medicare Advantage Reimbursement: Using Intelligent Analysis of the Clinical Record

Dr. Darren Schulte

Medicare Advantage (MA) plans and providers spend much time, effort and resources on activities to properly risk adjust for beneficiaries given their burden of chronic disease. Many organizations audit MA beneficiary medical charts to avoid missing coding opportunities during each HCC reporting year. This may cost anywhere from $30 to $50 or more per chart. While there are many claims-based vendor solutions to uncover suspect diagnosis codes and to better target potential audit and documentation gaps, these tools miss many opportunities only found in the clinical record.

In this webinar, Apixio describes innovative and intelligent analytics to automatically expose actionable opportunities to improve risk adjustment factor scoring by automatically extracting relevant diagnoses in clinical narrative using both text and scanned documents and comparing them against claims data to identify information gaps. The model leverages big data analytic techniques to determine where information gaps which can be addressed by coders to improve both chart audit productivity and also uncover additional opportunities for reimbursement.

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