The client operates ER (Emergency Department) across the US. The revenue per year is $22M with an average of 18,000 visits per month. They have a collective total of 45 billing/collections staff, both onshore and offshore.
The client incurred revenue loss due to inaccurate charging and coding processes for (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.