HCC Profiler

Apixio is reimagining personal health by uncovering insights from real-world care. Powered by data science and a patented computer learning and text mining technology platform, we analyze real-world clinical datasets to create, group and learn from personal health information to facilitate optimal personal healthcare.

Our innovative HCC Profiler is built upon the insights gained from analyzing health data from more than 2.4 million patients. The patented HCC Solution enables organizations to text mine patient chart information directly from the EMR or scanned documents to: identify codes, find documentation gaps and validate submitted codes, faster and more accurately than ever before.  

Risk Adjustment Reimagined.

Code Identifier Documentation Gaps

Code Validation

Key Differentiators

• Code up to 3 times more charts per hour througha secure web-based application, built upon theexperience and analysis of the health information ofmore than 2.4 million patients

• Securely acquire hospital and clinic encounter notesusing direct EHR interfaces

• Read unlimited amounts of scanned charts usingadvanced optical reading technology

• Mine varied encounter notes for unreported HCCconditions and missing document data using apatented computer learning system

• Intelligently route HCC coding opportunities to theright coders to approve them for submission

• Facilitate coder team productivity and accuracyduring a project with robust analytics

“The customer service from the Apixio team is excellent. They provided timely and thorough assistance to us on an ongoing basis.”

Barbara Johansen, CPC Senior Auditor, HCC Risk Adjustment Team Scripps Health Plan

“The HCC Profiler has allowed us to mine our EHR and scanned chart data for valid, risk-adjusting conditions with incredible transparency and efficiency. ”

Jennifer Pereur Director, Government Programs Hill Physicians

Solution Overview

The HCC Profiler is currently available for MA risk adjustment. It can be used as an application to support your internal coding activities, or as a service, depending upon your organization’s needs and capabilities. When used as a service, Apixio works with an expert third-party coding firm, approved by the customer, to provide appropriate review and approval of the HCC Profiler results.

Code Validation Module

The Code Validation Module confirms s ubmitted c odes a nd i dentifies po ssible de letes. C o de validation begins by text mining all available hospital and clinic chart notes during a given reporting period for all HCC coding opportunities. Coders then review and approve these coding opportunities using the secure HCC Profiler web application.

The approved codes become the definitive HCC set for the eligible members under analysis. The Code Validation engine then compares the HCC set with the Medicare submitted data to designate reported codes as either ‘confirmed’ or ‘possible deletes’ for consideration.

Code Identifier Module

Documentation Gap Module

The Documentation Gap Module searches through available member charts to identify encounter notes with attributed HCCs that lack critical documentation elements required for Medicare submission.

Identified document gaps are presented to coders in the HCC Profiler web application for rapid review and agreement. The approved gaps are then presented in a report, which includes the document identifier, HCC code, associated ICD code, and the rendering provider, to enable targeted physician feedback and action.

Documentation Gaps

The Code Identifier Module mines available member charts and Medicare reported data using patented computer learning to identify new coding opportunities for quick coder review. With the Code Identifier Module, coders can now review a chart in a targeted approach using our secure Profiler web application, increasing their productivity by more than 300% over manual review.

Demonstrated Results (Second Pass Analysis)

sales@apixio.com

www.apixio.com

1825 South Grant St.Suite 350, San Mateo, CA, 94402

877-427-4946

Health Plan CA Scanned Data 24,733

MembersOrganization Data SourceState

83

RAF Gain

Health Plan OR Scanned Data 23,916Health Plan FL Scanned Data 15,669

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