Prospective and Concurrent Risk Adjustment

Improve Point-of-Care Risk Capture and Care Delivery with AI

Surface actionable condition insights at the point-of-care with AI-powered solutions that streamline prospective risk capture and support complete, accurate coding and documentation.

Lighten Your Administrative Load While Closing More Diagnosis and Documentation Gaps

Prospective and concurrent diagnosis capture, documentation, and coding activities are critical as value-based reimbursement programs continue as the market matures. But manual processes, disconnected workflows, and ad-hoc communications make it difficult for providers to scale support for these important administrative programs while also delivering timely, informed care to patients.

With Apixio’s AI-powered and EHR-integrated prospective and concurrent risk adjustment solutions, clinical documentation integrity (CDI) specialists, reviewers/coders, and clinical teams are able to effectively work together to close care gaps and ensure complete, accurate clinical documentation while streamlining processes across pre-visit planning, point-of-care, and post-encounter reviews.
Close Diagnosis Gaps Faster And With Less Friction
Ensure Complete Documentation And Coding
Reduce Administrative Overhead
Benefits

Transform Data Into Insights

Distill structured and unstructured data into a comprehensive view of actionable patient insights.

Simplify Pre-Visit Planning

Review recaptured and suspected conditions in a centralized, AI-powered workflow.

Share Condition Insights Seamlessly

Send reviewer-triaged insights directly to your EHR for clinical assessment.

Accelerate Concurrent Reviews

Quickly ensure complete diagnosis capture and documentation before claims submission.

Amplify Point-of-Care Risk Capture and Care Delivery

Features

Comprehensive view of clinical and administrative data by patient

AI-powered diagnosis gap suspect and recapture conditions

Clinical workflow integration using APIs or EHR connectors

Intelligent work queue with customizable filtering logic and evidence highlighting

Query clinical staff within EHR workflows to streamline gap closure

Monitor and track clinically-amended encounters in real time

AI-as-a-Service for Prospective and Concurrent Risk Adjustment

Recapture known patient conditions and close diagnosis gaps at the point-of-care with flexible AI services delivered in any workflow.
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Prospective Risk Adjustment
Frequently Asked Questions

Prospective risk adjustment involves a proactive strategy to manage chronic diagnoses (recapture) and suspected conditions identified through labs, medications, reports, documentation, and other data sources. These are assessed, prioritized, and resolved during the patient encounter at the point of care.

The difference between prospective and retrospective risk adjustment is that prospective looks to prevent coding issues, while retrospective catches issues that were made.

Concurrent risk adjustment happens after the patient encounter but before claims processing. During this period, provider staff can review clinical documentation to ensure it meets HCC coding requirements and satisfies MEAT criteria:

  • Monitor for signs, symptoms, and disease progression and regression
  • Evaluate test results, medication effectiveness, and response to treatment
  • Assess and address test results and medical records; discuss with patients
  • Treat with medications, therapies, and other modalities

Concurrent risk adjustment also allows clinical staff to search for under-documented risk opportunities and ensure all codes and conditions are complete and accurate.

Apixio’s Prospective Risk Adjustment Suite integrates with all the leading EHRs (Epic, Cerner, athenahealth, NextGen, and more), leveraging EHR and FHIR® APIs for read-and-write capabilities.

Streamline and Scale Prospective and Concurrent Risk Adjustment Programs with Apixio

Explore how Apixio can support your organization’s unique prospective risk adjustment and care delivery needs.