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Blog   |   11.3.21

Reduce Audit Risk with the Right Retrospective Solution

Blog Cover - Reduce Audit Risk with the Right Retrospective Solution

As a result of 20 MA insurers receiving $9.2 billion in combined overpayments, the Office of the Inspector General (OIG ) has recently called for more chart review oversight – meaning that now more than ever is the time to ensure that your risk adjustment program data is accurate.

While traditional solutions manually look through charts and encounter notes to identify net new HCCs and supporting documentation, there is room for error that could have a costly effect on your operations. According to CMS, 19% of Medicare risk adjustment payments lack sufficient documentation, putting your organization at risk for audit. To avoid this, Apixio recommends that health plans and providers utilize an AI solution that not only analyzes and audits HCCs to determine codes that lack supporting evidence in the chart but also removes the time-consuming burden of manual audit reviews.

Apixio’s HCC Auditor offers just the solution. 

Our retrospective risk adjustment solution utilizes AI algorithms to identify submitted codes on charts and encounter notes that lack sufficient evidence. 

HCC Auditor improves productivity and coder oversight. Our platform provides full control of auditor project workflows, assignments, and performance tracking, enabling the ability to quickly evaluate reviewer speed and accuracy with robust and transparent insights and dashboards. By submitting deletes during the appropriate reporting windows, your team can protect your program from audit risk and optimize auditing performance, culminating in a risk profile that is as accurate as possible. 

Named the 2020 Best in KLAS Software & Services by KLAS Research, our retrospective solution provides reliable analytics tools to support risk adjustment programs for MA, ACA, and Medicare ACO member populations. In doing so,  HCC Auditor helps ensure organizations take the proper steps to avoid overpayments.

Contact us to learn how Apixio’s HCC Auditor solution can help maximize your accuracy and reduce audit risk, all while confirming the integrity of your HCC submissions.

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Udorn Chanthavong