Category: Coding

What America Can Learn from the U.K.’s Experience with Risk Adjustment and Population Health

Andrew Raymore

  We’ve discussed on the Apixio blog how critical risk adjustment is to the functioning of a healthy insurance market in the U.S., but how is risk adjustment applied in the healthcare systems of other countries? What makes this a fascinating question is that many other countries provide health insurance for a greater percentage of […]

4 Things Risk Adjustment Leaders Need To Know About the 2018 CMS Final Call Letter

Anita Joseph

Recently, the Centers for Medicare & Medicaid Services (CMS) released its Final Medicare Advantage (MA) Part C and D Call Notice for 2018. We combed through the  notice, and here is what we think risk adjustment professionals need to know.   1. What is the final call notice and why is it important to risk […]

2017 RISE Nashville Recap: Transforming Healthcare Through Data

Anita Joseph

At the 2017 RISE Nashville conference Apixio hosted a panel with four of our clients: Doug Loop of OptumCare, Russ Shust of Group Health Cooperative, Jennifer Pereur of Hill Physicians Medical Group, and Alicia Wilbur of Martin’s Point Health Care. The panel was moderated by Tam Pham,a risk adjustment expert, currently on board with Apixio […]

Ten ICD-10 Codes for Winter

Andrew Raymore

  Jack frost still nipping at your nose? I’ve got some bad news for you. Today is Groundhog Day, and unfortunately the little guy saw his shadow and we can expect 6 more weeks of winter (no, seriously the Weather Channel reported on this).   So we’re in for a tricky time, and we hope […]

Top 5 Questions Facing Risk Adjustment in 2017

Anita Joseph

From the looks of it, 2017 will be a big year for risk adjustment. There is a new administration in power in Washington, which will have far-reaching implications for the entire healthcare industry. And the risk adjustment space specifically will have to look inward, as it manages the currents of technological change and pries itself away […]

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 […]

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 […]