Apixio Launches AI Healthcare Audit Solution

Apixio is using artificial intelligence (AI) to make healthcare audits simpler and more efficient for all involved. The San Mateo, CA-based company is launching an AI solution called the HC Auditor, 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. “The key is to solve the problem physicians and hospitals are grappling with today,” Darren Schulte, MD and CEO of Apixio, told MD+DI. “The problems they’re dealing with are; what they’re being paid for; their healthcare delivery challenges; and how technology can help them today.” The HCC Auditor uses Apixio’s machine learning technology to link medical records to submitted diagnosis codes and determine whether there is sufficient documentation in patient encounter notes per coding guidelines. About 85% to 95% of risk adjustment payments for MA plans are based upon diagnosis codes on encounter claims from clinics and hospitals. The remaining 5% to 15% of payment comes from chart coding. The supporting patient notes, which are linked to codes from physician offices, are not typical...
Source: MDDI - Category: Medical Devices Authors: Tags: Software Business Source Type: news