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Apixio Launches HCC Auditor, AI-Powered Risk Adjustment Auditing Solution

July 29, 2018 / insidebigdata

Apixio Inc., the data science company for healthcare, announced availability of the AI-powered solution to help health plans and provider organizations to undertake internal audits of their risk adjustment payment data with increased accuracy and in far less time than traditional methods. Medicare is increasing the frequency of health plans audits offering Medicare Advantage (MA) products to ensure correct payments. Given the potential revenue impact, it typically takes health plans and provider organizations two to three times longer to perform a thorough review of reported diagnosis codes. About 85 to 95 percent of risk adjustment payments for MA plans are based upon diagnosis codes on encounter claims from clinics and hospitals. The remaining 5 to 15 percent of payment comes from chart coding. The supporting patient notes, which are linked to codes from physician offices, are not typically reviewed by health plans prior to submission for payment. Unless a physician practice is emplo...