1. / Emergency Department – Coding Improvement

The client operates ER (Emergency Department) across the US. The revenue per year is $22M with an average of 18000 visits per month. They have a collective total of 45 billing/collections staff, both onshore and offshore. In client incurred revenue loss due to inaccurate charging and coding processes for emergency department (ED) patients. The inconsistencies and reduced quality of the processes not only hindered the performance but also lead to denial of claims. The deployment AI-based tool for predicting the erroneously coded chart and generating audit samples led to improvement in accuracy, consistency in coding, and error prediction. It also enhanced revenue, while also lowering costs, reducing the number of failed claims and improving coding accuracy.

  • Inconsistency in coding performance and drop in quality
  • Reduced acuity and revenue per encounter
  • Denied claim due to charge and coding issues
  • Timely filing denials due to delay in receiving documentation and missing charges
  • High rate of eligibility related denials and incomplete demographic information
  • The non-tracking of several Underpayment issues
  • Unidentified compliance risks

Based on the assessment, the Apexon team recommended the following technology initiatives to transform the reconciliation and quality procedures.

  • Usage of technology such as Assisted coding and error prediction tool to improve accuracy and consistency in coding
  • Implementing high-level reporting solution to identify any anomaly and address the same
  • 100% eligibility verification before submitting a claim to the payer
  • Change in the workflow to improve the overall process efficiency
  • Trained the team on coding standards and implementing process guidelines to handle regular coding denials

A strategic approach towards quality led to the creation of an AI-based automation tool. This resulted in accurate and timely predicting of the erroneously coded chart and generating audit samples which were crucial in improving the performance and revenue. It delivered the following.

  1. It helped maintain manually coded/ auto coded sheet based on daily coded data and corresponding audits
  2. Performed as an error prediction tool with customizable algorithm for predicting error codes and the likely reason for the inaccuracy
  3. It helped in prioritizing error charts with maximum error propensity across different critical to quality fields
  4. It helped in generating reports and monitoring quality with an eye on improving the coding process

Apexon helped the client on enhancing several performance metrics and opportunities for revenue improvement by streamlining of coding technology and services for the client. They have since gone on to realize these stated benefits and much more as state below:

  • Allocated 40-50% Staff Redeployment
  • 60% Quality Improvement
  • Zero IT maintenance and audit bias
  • There was a $12 increase in the overall revenue per visit billed compared to previous years
  • The days in AR was maintained with 40 days
  • Overall 90+ AR was at 10%

Other Case Studies
A large container operator implements centralized data warehouse to improve data quality by 30%

Case Studies

A large container operator implements centralized data warehouse to improve data quality by 30%

Learn how we assisted a Danish business conglomerate with activities in the transport, logistics and energy sectors to implement a centralized Data warehouse to improve their data quality, analyze the business trend and performance.

A major US bank holding company reduced data anomaly and mismatch errors by 60%.

Case Studies

A major US bank holding company reduced data anomaly and mismatch errors by 60%.

Discover how we aided a leading US bank holding company headquartered in Michigan with capability enhancements that ensure a long-term process that reduces data anomaly and mismatch errors, improves operations, and mitigates risks.

Emergency Department – Coding Improvement

Case Studies

Emergency Department – Coding Improvement

Learn how we assisted a leading revenue cycle management services company in the United States in identifying opportunities to improve documentation while also modifying and automating its reconciliation and quality procedures.

US-based Physicians Group Improves ROI by 6X

Case Studies

Healthcare & Life Sciences
US-based Physicians Group Improves ROI by 6X

Learn how we helped a large physicians group based in the US use deep learning models to improve error identification by 3x and reduce financial leakage by 40%.

Let’s head to the apex

Get in touch and let’s start a conversation!