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Protect your organization from audit risk with AI

Retrospective coding programs have come under increasing scrutiny from CMS and HHS. AI-powered risk adjustment compliance solutions can help your team audit submitted codes efficiently and accurately.

Compliant code submissions. Efficient workflows.

Every coding team prides itself on the accuracy of their work. However, a recent survey found that most risk adjustment teams only have time to QA 10% of coding decisions, and these manual reviews are time consuming, costly, and often done haphazardly at the end of a long coding season. AI can help direct your organization’s compliance efforts and perform audits efficiently so you get the most out of your reviews.

HCC Identifier Performance Dashboard 2020

Benefits of AI-powered coding audits

  • Focus. Targeted identification of areas of potential non-compliance.
  • Efficiency. Reduced time to review coding decisions and supporting evidence.
  • Accuracy. More complete evaluation of potential audit risk with less effort.
  • Flexibility. Customized workflows to help organizations focus on what matters most.

Our solutions

HCC Complete

HCC Complete uses proven AI algorithms to support a comprehensive retrospective chart review experience for Medicare Advantage and Affordable Care Act programs. Our technology identifies both net-new coding opportunities and unsupported known codes and serves them up for coding and auditing in a straightforward workflow.

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HCC Auditor

HCC codes from supplemental data are closely scrutinized for both Medicare Advantage and ACA risk adjustment programs. Apixio’s HCC Auditor solution uses AI algorithms to confirm whether there’s sufficient evidence in patient charts to support submitted HCCs. Reviewers can then evaluate whether required documentation elements are missing and flag unsupported codes for remediation or deletion.

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Zero Evidence Report

Condition codes are often submitted by physician offices without the necessary supporting evidence for HCC coding, which puts health plans and providers at compliance risk. Apixio’s Zero Evidence Report identifies codes submitted to CMS on claims that lack appropriate evidence in source encounter notes, helping your organization identify areas for physician training and potential code deletes.

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