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.

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

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