The Apixio Blog

How New Risk Adjustment Technology is Affecting Coders

Technology is transforming risk adjustment, just like it is every other part of society. Instead of people traveling to physicians’ offices and physically scanning their records, technology can get charts quickly and securely. Instead of coders thumbing through thousands of pages of patient charts to find HCCs, technology can identify potential HCCs without anyone lifting a finger. And technology can report out HCC information with accuracy and detail.

For coders, this change can sound like cause for fear. It can seem like coders are being replaced with a machine. But that is far from true.

It’s true that risk adjustment technology has come a long way in ten years, and is remarkably sophisticated, by any industry’s standards. However, this new technology is not replacing coders. Like any other tool, it needs guidance, subject matter expertise, and oversight. This is why HCC Profiler, Apixio’s risk adjustment application, presents codes found by Apixio’s Iris platform to coders for review: Coders are the ultimate arbiter of whether codes are valid. Risk adjustment is an exceptionally complicated endeavor and each organization has different guidelines for evidencing HCCs. For this reason, coders review the technology’s results and serve as important overseers of its work.

This role in the risk adjustment process is very different than the one coders have traditionally had.

The role involves less hunting and gathering and more effectively leverages their expertise. The coder no longer finds the original code, they review what the technology has found. Making this system work means letting go of ground-level steps of the coding process. The technology exists to eliminate basic work like going through individual charts. Taking advantage of the technology means trusting that the technology will, indeed, execute these steps well even if it is behind the scenes.

The coder’s new role also means embracing new workflows and interfaces. For many years, coding has meant searching through a medical chart that looks a certain way, and what the technology presents will inevitably look different. The way a coder works will also be different, it’ll be in short spurts, looking at charts of many different patients, rather than doing a deep dive into one.

This level of change can, but doesn’t need to be, an obstacle to technology adoption. These changes increase accuracy and efficiency of the risk adjustment process as a whole. They allow coders to focus on one HCC at a time, prevent duplicate work, and enable stronger project management. Coders and technology together can make risk adjustment more accurate than ever before, and enables a more precise picture of a patients health resulting in better more accurate care.

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