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