Time to Rethink Your Risk Adjustment

The bread and butter of MA plan success

A million new members join Medicare Advantage each year, but reporting timelines remain static. MA plans are being asked to code for more patients, more accurately, with no more time— and the cost of failure is steep.

Commercial risk adjustment is high stakes

For 2015, risk adjustment transfers averaged 10% of individual market premiums and 6% of small group market premiums. There’s no way around it— poor risk adjustment reporting means financial trouble for plans on the commercial exchanges.

HCC Profiler drives the most accurate and complete MA and Commercial risk adjustment. Period.

Obtain patient charts without bothering physician offices.

Instead of the traditional process of acquiring and sorting through paper and electronic charts, we can extract data directly from EHRs. This unique feature makes chart acquisition simple, reliable, secure and repeatable— no more visits from chart acquisition vendors. (We also can extract data from scanned and faxed documents if you prefer it.)


Find out more here.

 Not ready to leave your existing vendor?

We hope you’ll let us be the first person to analyze your patient charts, so you can get a complete picture of your risk as soon as possible. But if you’re not ready to move your risk adjustment to 100% cognitive computing just yet, we understand. Let us audit your vendor, to ensure coding guideline compliance and accuracy, and to make sure you’ve actually found everything. We’re confident you’ll see what you’re missing.

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Three ways to use HCC Profiler:

Code Identifier

Mine available member charts to identify new HCC codes and put them in front of expert coders (ours or yours) for rapid confirmation or reject.

Code Validation

Confirm submitted codes and identifies possible corrections or deletes, to ensure that reporting is accurate in case of RADV or RAC audit.

Documentation Gaps

Identify encounter notes with attributable HCCs that lack critical documentation elements required for submission. Use report to target and facilitate provider education.

Success Stories

“At Hill Physicians Medical Group, we’ve previously relied on tedious manual review of our charts. The HCC Profiler has allowed us to mine our EHR and scanned chart data for valid, risk-adjusting conditions with incredible transparency and efficiency. It helps us ensure an accurate clinical record which enables us to deliver high-quality care to the patients we serve.”

Jennifer Pereur

Director of Government Programs, Hill Physicians

"As an experienced HCC risk adjustment auditor, I've been astonished to discover how Apixio's clean, simple interface facilitates identification of diagnosis capture opportunities at a level of efficiency and detail no other auditing program has ever delivered."

Ellen Lingar

QA Specialist

 Flexible EHR integration and document extraction

HCC Profiler works with many different EHR and document types: