1. / An EMS Firm Makes Coding and Processing Time 4x Faster
Overview

Healthcare reform in the United States has led to burgeoning growth in ambulance and emergency medical services. However, the increase in business has also resulted in a need for stricter compliance protocols, especially within billing and claims. 

On this project, Apexon was called in to deliver a low-cost billing solution that simplified the claims processing procedure, while maintaining compliance with existing medical codification at the federal level.

Problem

While processing 5,000 ambulance trips on a daily basis, the client found it difficult to:

  • Process a high volume of claims quickly, accurately, and at low-cost
  • Develop a standardized format to capture patient care reports
  • Manage costs, since the current system of manual claims processing was labor-intensive and created a higher likelihood of costly errors
Solution

Apexon’s EMS Coding Solution simplifies the medical coding process by determining the appropriate service codes using a machine algorithm, reducing errors that are introduced during traditional manual processing. Run on an AWS application server, this system allows us to:

  • Use machine learning and advanced NLP to automate claims generation and processing
  • Process all four aspects of ambulatory care coding – Medical Necessity, Priority, Level of Service, and ICD1O coding – with greater accuracy and over shorter time frames
  • Deliver client access to the solution via an API-enabled, encrypted web application, that meets HIPAA compliance protocols
Impact

Using Open Source R to create a statistical computing solution, Apexon was able to deliver a number of benefits to the client. These included:

  • 75% automation within billing and claims processing 
  • High claims processing accuracy – over 95% of claims processed correctly
  • A 4x faster processing time and a significant reduction in the number of denials
  • Reduced administrative costs for the entire billing and claims process

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