SaaS app built on cognitive computing platform helps with medical codes

Darren Schulte, M.D., didn’t go to medical school to practice medicine.

“I went to medical school, actually, for the express purpose of trying to change the practice of medicine,” he said.

Schulte is working to do that as CEO of Apixio, a company based in San Mateo, Calif., that has developed a software-as-a-service (SaaS), web-based application called HCC Profiler that runs off of Apixio’s cognitive computing platform, Iris.

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HCC Profiler reviews thousands of doctors’ notes and electronic health records (EHR) to make sure the correct medical codes are assigned to the right patient for the right illnesses and procedures that the patient has so that the healthcare organization will be properly reimbursed via Medicare Advantage (also known as Medicare Part C).

Darren Schulte

Schulte explained that patient records and files are exported securely to the Amazon cloud from the EHR using proprietary software configurations. Then, the cognitive computing platform, with the help of algorithms, will read through and analyze the data and find the relevant information about the patient concerning a chronic disease, for example. Then, through the HCC Profiler application, coders are presented the findings to review and either accept or reject and will assign the correct medical codes for reimbursement via a dashboard. Users of the HCC profiler do not need to implement Apixio’s cognitive computing platform, Iris, in order to use the HCC Profiler. Healthcare organizations access the web-based application and performance dashboard via the cloud and the cognitive platform is the underlying layer powering the application.

“There’s this huge communication gap between what the doctor has identified and what actually makes it all the way back up the food chain in Medicare,” Don Brandeburg, director of health IT at Chinese Community Health Care Association (CCHCA) in San Francisco, said.

Brandeburg and Schulte explained that Medicare Advantage pays CCHCA depending on the severity of the population’s illnesses.

There’s this huge communication gap between what the doctor has identified and what actually makes it all the way back up the food chain in Medicare.

Don Brandeburgdirector of health IT at CCHCA

“In order to get appropriately reimbursed and understand their population better, [CCHCA uses] our HCC Profiler tool to better determine the chronic conditions they’re actively treating for that population,” Schulte said.

Brandeburg added that “the doctor may be treating you for diabetes, but if they forget to actually put the diabetes code on a claim, then our reimbursement drops a huge amount even though we’re still trying to take care of a diabetic patient, which is costly.”

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