Lighten Your Administrative Load While Closing More Diagnosis and Documentation Gaps
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.
Transform Data Into Insights
Simplify Pre-Visit Planning
Share Condition Insights Seamlessly
Accelerate Concurrent Reviews
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
Prospective Risk Adjustment
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.
