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Conquering Commercial Risk Adjustment

Anita Joseph

Risk Adjustment an Important Business Factor for Commercial Exchange Plans In theory, the commercial risk adjustment program was intended to help insurers taking on the heaviest load from the commercial health exchanges. Health insurers would submit risk scores for each enrolled patient to HHS. HHS would calculate an average risk score for each plan and then mandate cash […]

3 Reasons to Care About Commercial Risk Adjustment

Anita Joseph

Participating in the commercial insurance exchanges isn’t easy. Plans have to develop a strategy for selling to individuals, set premiums, explain their network offerings to an entirely new consumer set, and orchestrate care for an unexpectedly sick population. Plus, they do all this in the face of intense public pressure and scrutiny. It’s no wonder […]

How A Veteran Coder Used Apixio’s HCC Profiler to Eliminate Data Entry Error and Double Productivity

Eric Tan, CPC, CCS

A veteran HCC coder, Gloria Rodriguez has seen the pros and cons of many approaches to HCC coding. At the beginning of her career, she “chased” and reviewed paper patient charts. Next, she reviewed electronic records through the EHR system or scanned PDF charts. Gloria currently reviews charts using Apixio’s HCC Profiler application. By using […]

How New Risk Adjustment Technology Affects Coders

Eric Tan, CPC, CCS

Risk adjustment is traditionally done in a manual and inefficient way, as we have discussed throughout this blog series. Coders will comb through thousands of pages of patient charts and look for documented chronic conditions. This process is time consuming and costly, not to mention that it doesn’t make good use of coders’ expertise. Cognitive […]

How We Use Machine Learning to Analyze Patient Data in Medical Records

Eric Tan, CPC, CCS

As we have covered in the first part our blog series, risk adjustment is traditionally done in a very manual and slow way. This process is time consuming and costly, not to mention that it doesn’t make good use of coders’ expertise. Because of these issues, cognitive computing can meet an important need for risk […]

How We Use Technology to Get Risk Adjustment Data Out of EHRs

Eric Tan, CPC, CCS

This is the second in a 4-part series called Intro to Risk Adjustment Technology. As we discussed in the first post in this series, traditional risk adjustment is incredibly manual. Coders will comb through thousands of pages of patient charts and look for documented chronic conditions. This process is time consuming and costly, not to mention that […]

Why Does Risk Adjustment Need Technology?

Eric Tan, CPC, CCS

This is the first in a 4-part series called Intro to Risk Adjustment Technology. Cognitive computing. Machine learning. Natural language processing. Two years ago, few people in the risk adjustment world had ever heard of these terms, and yet today they are becoming synonymous with risk adjustment. What are these technologies? Why do we even need them […]

Results from RISE and Apixio’s Coding Community Survey

Lea Cuniberti-Duran

In January, Apixio’s user research team conducted a coding survey. We recruited coders, QA supervisors, and directors involved in risk adjustment coding via RISE’s mailing list, Facebook groups, and LinkedIn groups. We secured 111 responses, from 52 coders, 23 coder managers, 13 director/executives, and 23 other affiliations. Below are some takeaways: The Risk Adjustment Coding […]

All About MACRA: Four Takeaways from CMS Chief Andy Slavitt’s Speech to the American Medical Association

Anita Joseph

On Monday, Centers for Medicare and Medicaid Services (CMS) Administrator Andy Slavitt addressed the American Medical Association’s 2016 annual meeting. Slavitt usually leverages such opportunities to send highly specific messages— at the JP Morgan Conference earlier this year, he told an audience of healthcare technology executives that interoperability had to be part of their mandate— […]