NHP* & ApixioAccelerating Risk Adjustment Performance Past Manual Review

About the Plan:

Project Overview

NHP retrieves 550,000 charts each year for retrospective Medicare Advantage (MA) risk adjustment review.

Project included chart review and QA of 75,000 charts acquired from providers practicing in 10 states across the country.

Results rigorously reviewed by NHP coding team.

National health plan (NHP) that cares for over 4 million Medicare and Medicaid patients in 19 states.

Designed to compare relative accuracy and productivity of Apixio’s HCC Profiler with manual chart review.

*Pseudonym

NHP has worked with Apixio for four years on first and second-level review.

Performance Gap

Coders Using Apixio 13.2/hour

Traditional Vendor 4.5/hour

Effective Chart Review Rate

Apixio Expertly Handles a Variety of Chart Formats

Apixio’s technology was able to interpret multiple formats of medical records for the plan throughout the three-year relationship, including scanned PDFs.

Platform Confirms That Records Meet Administrative Requirements for Validation

+ Correct Date of Service

+ Valid Provider

+ Allowable Provider Type

NHP

/ / @Apixio / apixio.com info@apixio.com | 1825 South Grant Street #350, San Mateo, CA 94402

Apixio © 2018. All rights reserved.

Performance Gap

Apixio 6566

Traditional Vendor 5044

Total HCCs Found

Apixio Augments Coder Accuracy, Decision Making and Speed

The results of the study were conclusive: With Apixio’s artificial intelligence (AI) platform, expert coders found 1,844 more new, supported HCCs compared with the coders using a manual review of the 75,000 chart set. The coders using Apixio were able to work at an effective rate of about 20 charts per hour, which is four times faster than their manual review rate. In addition, NHP was able to gain greater insights into coder decision making by finding instances in which the coders inappropriately rejected a correct algorithm result. With the HCC Profiler multi-tiered QA workflow, coding supervisors were also able to identify coding disagreements and determine the areas for further coder training.

NHP Supported By Experienced Apixio Team

To ensure success, NHP was assigned an experienced project management team from Apixio. It included an executive sponsor, account executive, customer success manager, integrations specialist, and medical coding lead. This seasoned group ensured data completeness, guided NHP through project planning and execution, and collaborated with NHP to align coding guidelines.