Faster, Scalable Review and QA Workflows
More Accurate View of Patient Conditions
Decreased Audit Risk and Review Lift
Apixio's Risk Adjustment Solutions Allow You to Review, Code, and Audit Charts with Confidence
Health plans and providers operate in an increasingly complex risk adjustment landscape. Administrative time and cost are skyrocketing as risk-based reimbursement models become more sophisticated. Audit scrutiny continues to grow as regulatory agencies conduct additional oversight to ensure payment accuracy. And new investments in prospective risk adjustment add operational complexity at the point-of-care.
Our AI-powered risk adjustment coding and auditing solutions help teams scale their chart review processes so they can capture a complete, consistent picture of patient health conditions and thrive within value-based care (VBC) programs.
The right risk adjustment solution improves your coding and audit accuracy, efficiency, and financial impact. Take your program to new heights with proven AI technology and centralized review workflows.
Accurate Intelligence
Efficient Review Workflows
Scalable Technology
Flexible Program Support
What Makes Apixio Different?
Speed, Efficiency, Completeness, and Accuracy
Risk adjustment solutions all seek to provide the same outcomes: speed, efficiency, completeness, and accuracy. What makes Apixio different? An unmatched blend of products and services that exceed client expectations every time.
Apixio’s technology offers a deeper, more nuanced look at records. Its efficient workflow and AI support means faster reviews by coders while, at the same time, using the full breadth of their expertise. And if a partner has a unique challenge? Our team is there to adapt, adjust, and deploy to meet their needs on transparent timelines that exceed client expectations every time. The results speak for themselves.
The Impact
Reduction
80% reduction in coding workload
Faster
5X faster chart reviews
More
Up to 20% more supported codes found
Accuracy
96%+ coding accuracy
Retrospective Risk Adjustment
Prospective & Concurrent Risk Adjustment
AI-as-a-Service for Retrospective Risk Adjustment
AI-as-a-Service for Prospective Risk Adjustment
Risk Adjustment
Risk adjustment programs of any configuration are the culmination of a complex blend of federal policy and business decision making to address the healthcare needs of populations. To help navigate that, we’ve built an FAQ to help explain how Apixio can help risk adjustment programs thrive with a partner that provides unmatched technology and service.
Risk adjustment (RA) is a method used by CMS and HHS to adjust healthcare payments to reflect the demographics and ongoing needs of a patient population. The goal is to ensure that organizations that serve needier patients receive additional funds to cover their higher cost of care.
Risk adjustment coding is the process for health plans and providers to accurately represent the full patient health profile for reimbursement. The process includes identifying demographics and diagnosis codes to understand the patient’s health profile. The codes are then calculated as a risk score for each patient. Health plans and risk-bearing providers are reimbursed for the health status of the patient population.
There are three risk adjustment models for different government programs. CMS-HCC risk adjustment model is used to adjust payment for Medicare Advantage, Medicare Shared Savings Program (MSSP), and other alternative payment models (APMs). The HHS-HCC is a risk adjustment model that calculates risk score concurrently for the Affordable Care Act (ACA).
Risk adjustment is a pivotal component of the Affordable Care Act (ACA), serving as a method to reimburse health insurance plans for variations in the health profiles of enrollees. This ensures that plan premiums accurately account for disparities in coverage scope and other plan-related factors.
Many companies offer risk adjustment solutions for healthcare, including actuarial and consulting firms, and healthcare technology companies, including Apixio, for retrospective and prospective risk adjustment.
