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Resources | Apixio – old

industry blog

industry blog

Paths to Success with ACA Risk Adjustment

Prior to the COVID-19 pandemic, risk capture was almost an afterthought for ACA populations. Today, it’s an integral part of any risk adjustment program. The 2023 benefit year alone is resulting in $10.3B in transfer payments. Today, we want to discuss what’s driving it and how the right risk adjustment partner can help ensure the […]

industry blog

industry blog

Payment Integrity Program Assessment

Assessing the effectiveness of your payment integrity strategy is crucial for ensuring financial accuracy and operational efficiency within your organization. By taking our assessment, you’ll gain valuable insights into your current payment integrity process for complex claims, such as High Dollar, DRG, and other clinical reviews. Discover areas for improvement and find out how you […]

industry blog

industry blog

Unlocking Health Data’s Potential Across the Enterprise

In a healthcare landscape perpetually driven by data, the ability to harness insights from health data isn’t just a competitive edge — it’s a necessity for growth, efficiency, and improved outcomes. For those entrenched in the complexities of value-based care and other outcomes-based arrangements, the question is not whether to engage with health data, but […]

industry blog

industry blog

Embracing the New Normal: Prospective Risk Adjustment

Embracing the New Normal: Prospective Risk Adjustment The healthcare industry is experiencing a significant transformation, shifting towards value-based care. With the shift to the new risk adjustment V28 model and increased pressure for compliance with the recent RADV ruling, prospective risk adjustment emerges as a pivotal strategy for healthcare providers and payers. This proactive approach […]

industry blog

industry blog

8 Ways to Streamline Your Prospective Risk Adjustment Program with AI

Your prospective risk adjustment team that are reviewers, whether clinical staff or coders on Clinical Documentation Improvement (CDI) teams, plays a critical role in value-based care program success. But this important contribution requires a huge operational undertaking. Ahead of scheduled patient visits, teams are tasked with reviewing large volumes of data spread across multiple health […]

industry blog

industry blog

3 Ways Modernizing Your Chart Management Will Support Health Plan Success

Managing health data is a headache for health plans, particularly patient charts. Without the right chart management processes, your health plan may be in an uphill battle — experiencing time-consuming, resource-intensive, and costly, redundant chart chases. However, by modernizing your chart management strategy with the right tools and technology, your organization can save time, reduce […]

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Additional Content

industry blog

industry blog

Navigating the Path to V28 Model: Developing Your Risk Adjustment Strategy

The healthcare coding landscape for Medicare Advantage (MA) significantly shifts based on the transition from the V24 to the V28 Hierarchical Condition Category (HCC) risk adjustment model. This evolution profoundly impacts health plans and providers, necessitating an understanding of the changes and their implications. Let’s explore what this shift entails and how organizations can navigate […]

industry blog

industry blog

Navigating Payment Integrity: Strategies for Success in 2024

The intricacies of payment integrity hold the industry in a perpetual state of adaptation. With data integrity and fiscal responsibility at the forefront, health plans need to manage cost containment efforts by driving down administrative costs and harnessing the power of technology. With shifting priorities, payers are prioritizing across all lines of businesses to directly […]

industry blog

industry blog

4 Considerations for Your ACO’s Prospective Risk Adjustment Program

In MSSP and ACO REACH, ACOs need to operationalize how to have a risk adjustment program, which is difficult to implement and scale without the right people, process, and technology. ACOs, whether existing or new entrants, need prospective risk adjustment tools that enable them to seamlessly and confidently capture risk and manage patient care. By […]

industry blog

industry blog

Navigating the RADV Ruling: Strategies for Health Plans to Ensure Compliance

The Center for Medicare Services (CMS) has announced its intent to use a new extrapolation policy to audit Medicare Advantage insurers’ reimbursement data, focusing on ensuring the accuracy of diagnosis data submitted for payment. The Risk Adjustment Data Validation (RADV) Final Rule will now carry a higher risk of penalties for unsupported diagnoses and is […]

industry blog

industry blog

How to Prepare for the 2023 Medicare Advantage Sweep Season

With the CMS extension coming to an end this July, risk adjustment teams will be expected to meet two CMS Medicare Advantage (MA) final deadlines within a matter of months – rather than a year that the industry is accustomed to. As a leader in the risk adjustment industry, we at Apixio know what it […]

industry blog

industry blog

3 Strategies to Maximize Risk Adjustment for MSSP & ACO REACH

To maximize shared savings, mastering risk adjustment is a critical factor for Accountable Care Organizations (ACOs) participating in MSSP, ACO REACH, and other alternative payment models. Unfortunately, however, many ACOs that participate in MSSP and ACO REACH don’t have a risk adjustment program in place that’s set up for success—or they may not have one […]

industry blog

industry blog

6 Provider Benefits of Prospective Risk Adjustment

As providers continue to expand their value-based contracts with payers, the administrative burden on clinical teams can be daunting, especially around documentation and coding. In order to best meet value-based care initiatives and avoid clinical burnout, healthcare teams would do themselves, and their patients, a service by participating in a prospective risk adjustment program —that […]

industry blog

industry blog

Eliminate Prior Authorization Pain Points with AI

Prior authorization, as it stands, is one of the more antiquated components of the healthcare system. Its impact causes frustration throughout the care continuum, primarily for health plans. From part one of our prior authorization series, 3 Major Challenges for Prior Authorization & How They Impact Your UM Goals, the current prior authorization process poses […]

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