Apixio Launches HCC Complete to Support Accurate Risk Adjustment

SAN MATEO, Calif., May 27, 2020 /PRNewswire/ — Apixio Inc., the AI healthcare analytics company, today announced the release of HCC Complete to its portfolio of risk adjustment solutions. Apixio’s HCC Complete uses the company’s industry-leading artificial intelligence platform to support a comprehensive chart review experience for Medicare Advantage (MA) and Affordable Care Act (ACA) organizations. HCC Complete identifies potential missed and unsupported, previously reported acute and chronic conditions used for risk adjustment. These identified conditions are presented in an intuitive, secure web application for coder review. With the aid of technology, coding teams using HCC Complete can conduct chart reviews in 80% less time than manual reviews and with significantly higher accuracy.

With greater scrutiny placed on government risk adjustment activities, plans and risk-bearing providers need technology to support compliant chart reviews with less time and effort. The Centers for Medicare & Medicaid (CMS), Department of Health & Human Services (HHS), Office of the Inspector General, and the Department of Justice are increasingly focused on overpayments and fraudulent reporting by healthcare organizations. However, comprehensively reviewing charts to both surface missing supported HCCs and identify coded HCCs lacking sufficient evidence is time-consuming, costly, and unscalable for most plans and providers. HCC Complete makes this process more efficient and comprehensive.

“For years, risk adjustment programs have struggled to calculate accurate member risk given incomplete encounter claims and the cost and effort required for chart retrieval and review. This becomes increasingly difficult as membership grows and guidelines change,” says Darren Schulte, MD, CEO of Apixio. “Using AI technology, risk adjustment programs can measure and report true individual risk while maintaining program compliance.”

HCC Complete uses AI algorithms trained with millions of charts and expert decisions to detect supporting documentation in physician notes for risk-adjusting diagnoses. Using HCC Complete, coders can easily find missing support for reported codes and capture new, previously unreported codes. Algorithms auto-confirm that evidence exists in physician notes for reported codes. Only diagnoses without discernable documentation in available charts are presented to coders for audit. In addition, coders can review diagnoses found by algorithms with evidence that were not reported on encounter claims. The platform also supports real-time project tracking and management with tools that provide insight into coder performance, and gives full control over project assignments and workflows. HCC Complete can analyze four to eight million charts per month, and the application can support thousands of concurrent coders. Project implementation takes less than a week.

HCC Complete is available as a cloud-based application or an AI-powered service solution for health plans and at-risk provider groups. For more information, visit www.apixio.com.

About Apixio
Improving healthcare outcomes requires access to the right data at the right time. Apixio is advancing value-based care with data-driven intelligence and analytics. Our AI-powered insights unlock actionable information from administrative and unstructured clinical data. The results drive better decision-making and a smarter approach to healthcare. Learn more at www.apixio.com.

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SOURCE Apixio Inc.