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Accurate, efficient risk adjustment coding & QA with AI

Whether you run a risk adjustment program at a health plan, at-risk provider group, or ACO, AI-powered chart reviews, analysis, and QA can improve your coding accuracy and efficiency.

Trusted technology. Proven results.

AI, ML, NLP. At Apixio, these acronyms are more than just tech buzzwords. These computational techniques provide the foundation for our risk adjustment coding and QA solutions, extracting insights from structured and unstructured healthcare data to support a streamlined, smarter approach to retrospective and prospective risk capture. Our solutions drive consistent value for 50+ health plan & provider clients nationwide.

AI-Powered Risk Adjustment Coding & QA

Benefits of AI-powered coding & QA

  • Accuracy. Accurate identification of risk-adjusting conditions.
  • Completeness. Fuller picture of population risk from clinical data.
  • Productivity. Review important supporting evidence for risk adjustment more quickly.
  • Flexibility. Supports pre-encounter, point-of-care, post-encounter, and retrospective coding.

Our solutions

HCC Identifier

HCC Identifier is the most efficient, accurate way to manage HCC coding projects for Medicare Advantage, ACA, and Medicare ACO programs. Our comprehensive chart review & QA solution is available as a web-based application for in-house coding teams or a full-service coding service for first-pass and second-pass reviews.

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Risk Adjustment for Medicare ACOs

Accurate risk adjustment is critical for ACOs participating in MSSP. Risk Adjustment for Medicare ACOs uses artificial intelligence (AI) to identify risk-adjusting patient conditions that haven’t been properly documented at the point of care or coded on claims, increasing your risk capture for Medicare patients. Our analytics solution powers targeted clerical error reopenings with your MAC, patient visit chase list development, and physician education programs to improve coding performance.

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Prospective Analytics

Running a paper-based prospective risk program? Our Prospective Analytics solution provides the same targeted AI-generated condition suspects and supporting evidence as Prospective Insights, but delivered in a simple report you can integrate into your existing initiatives such as direct-mail or fax-based programs to improve condition capture at the point of care.

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Prospective Insights

Internal costs and external regulatory changes are putting pressure on plans and providers to move risk capture upstream. Prospective Insights delivers AI-generated patient suspects for risk-adjusting conditions in an integrated workflow within physician EHRs, providing timely intelligence to inform assessment, treatment, documentation, and coding at the point of care. As a result, providers develop a clearer picture of patient conditions and plans recognize risk-related revenue earlier in the payment year.

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Documentation Gaps

Providers serving MA and ACA patients don’t always document patient encounters with HCC coding in mind. Apixio’s Documentation Gaps solution identifies encounter notes with attributed HCCs lacking critical documentation elements required for submission. Gaps are attributed to specific providers and include missing elements and dates of service so you can follow up with physicians to close gaps and improve their documentation approach.

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Learn more about how Apixio’s coding & QA solutions can support your risk adjustment program success.