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Blog   |   1.23.21

Why The CMS Extension Is An Opportunity

Why The CMS Extension Is An Opportunity

Understanding that 2020 was a challenging year, the Centers for Medicare & Medicaid Services (CMS) has granted a reporting extension for Payment Year’s 2020, 2021, 2022, and 2023 for Medicare Advantage (MA) enrollees. Industry experts are advising clients to take advantage of this added window to maximize Risk Adjustment Factor (RAF) values along with the auditing of information, especially telehealth charts. At a RISE conference in November 2020, almost 60% of attendees indicated making plans to take advantage of the added time. Apixio is working with many of our health plan clients and prospects as they consider using the added time to help with second-pass chart coding, ensure compliance through audits, and improve their financial performance.

Apixio, using our robust AI platform, has worked for over six years with leading health plans and providers to maximize MA risk capture while remaining in compliance with documentation requirements. Many of these efforts have been part of a second-pass project process where our platform takes another look at charts to ensure that all potential Hierarchical Condition Category (HCC) codes are appropriately captured.  

We recently evaluated the results of over 20 second-pass projects in the past year, and in every project, we found net-new HCCs generating on average a positive 4:1 Return for our clients.

Average Project SizeAverage Project DurationAverage Client Agreement Rate# of Charts Reviewed per Code FoundAverage Return
67,500 charts13.5 weeks92%1234.12

One of our payer clients was pleasantly surprised by our second-pass coding results. After first-pass coding was done from a large risk adjustment vendor, Apixio performed a second-pass chart review with our AI platform and found one new code per every 29 charts reviewed. In doing so, we helped them obtain an additional $3.2 million based on analyzing roughly 40,000 charts.

While these financial results are impressive, the other significant benefits are that it allows our clients to evaluate the quality of their first-pass chart review processes, while making adjustments to items such as the training processes, coding guidelines, provider education, and even consider changing vendors.

As you consider your plans with the CMS extension, discuss with an expert on your team how you can leverage the market-leading risk adjustment solution, HCC Identifier, to maximize value for your organization.

Udorn Chanthavong Profile Image
Udorn Chanthavong