AI-as-a-Service for Retrospective Risk Adjustment

Reliable Diagnosis Intelligence, Delivered Wherever You Need It

Leverage the power of AI to extract condition insights and present clear, concise recommendations for reviewers within your existing coding workflows.

How We Support Retrospective Risk Adjustment Reviews

Risk adjustment programs—especially for Medicare Advantage (MA) and Affordable Care Act (ACA), Alternative Payment Models (APMs) for the Medicare Shared Savings Program (MSSP), and ACO Realizing Equity, Access, and Community Health (ACO REACH)—are charged with accurately capturing the disease burden across their population for proper reimbursement.

Apixio’s AI-as-a-Service for Retrospective Risk Adjustment solution is designed to help coding teams strengthen their retrospective chart review programs with AI-driven intelligence embedded into your existing workflow that ensures complete and accurate coding for retrospective risk adjustment submissions.
Streamline Chart Reviews
Identify Missed Coding Opportunities Faster
Leverage AI Insights In Existing Workflows
Benefits

Improve Coding Accuracy

Identify missed coding opportunities within retrospective review workflows.

Review Charts More Quickly

Present data-driven condition suspects to reviewers to help them validate, code, and QA charts faster.

Integrate Insights Seamlessly

Send AI-powered diagnosis insights to your existing systems using flexible, interoperable APIs.

Control of Your Process

Leverage external insights to power up your risk adjustment process—no new technology or workflows are needed.

The Impact

90%

Avg ICD-10

90% average ICD-10 level precision

3.1

Avg HCCs

3.1 average HCCs per chart

1.19

Avg RAF

1.19 average RAF per chart

Features

Transform clinical detail into actionable insights for coding with AI

Normalize data and extract relevant ICD-10 diagnosis codes with SNOMED-level specificity

Present applicable HCCs with actionable insights and supporting evidence

Alternatively view and validate findings in an intuitive UI

Submit HCC and RAF calculations to your workflows using JSON APIs

Increase Your Risk Adjustment Impact with Apixio

Explore how Apixio can support your organization’s unique risk adjustment coding and workflow needs.