Frequently Asked Questions

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.

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.

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

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.