HOW CODING AUTOMATION REMOVES GUESSWORK FROM AMBULANCE REVENUE CYCLE MANAGEMENT

Ambulance trip coding and auditing is a very specialized form of developer expertise. And while integrating technology to solve problems is a sensible decision, finding well-trained and certified EMS coders is an oft-cited concern. When you factor in the constantly shifting landscape of compliance and healthcare regulations, keeping up with the rules while reducing reliance on manual claims processing becomes increasingly difficult for EMS providers.

Ambulance coding is unlike any other type of coding discipline. It requires a separate set of codes that are not utilized by physician or hospital services. The EMS coding and documentation requirements are not only distinctive, but they are also noticeably different from the code written by other healthcare coders. The process is also complex and must include specific codes, modifiers, indicators, and exceptions.

EMS providers do not work to a specific schedule. Medical emergencies are, by their very nature, unexpected while ambulance crews have to be prepared for varying degrees of criticality and patient requirement. When you also factor in the insurance claims processing ecosystem, then the challenges impacting Ambulance Revenue Cycle Management (ARCM) can be significant.

For example, maintaining high-quality patient care while dealing with the limited financial flow is a typical issue for many ambulance firms. Additionally, an ambulance coder must consider the unpredictability of patient intake as well as other considerations to provide an accurate and compliant claim. Patient wellness is often a critical factor of EMS with the provider needing to ensure that every box is ticked.

Taking that into account, there are areas of concern and care that have a direct impact on ARCM.

Automating the billing process is already part of digital healthcare. And the coding for provided services is an aspect that lends itself particularly well to automation.

For example, coding automation comprises analyzing electronic Patient Care Reports (ePCR) with a computer application to establish appropriate output codes for the level of service, priority, medical necessity of transport, and ICD10 for emergency medical services. By automating these tasks, providers can experience significant benefits, including:

Apexon offers an advanced analytics solution called ApexEMS. This platform includes customizable business intelligence tools and can provide insightful revenue cycle analytics.

By using ApexEMS, ambulance companies can introduce results-oriented actions based on data. ApexEMS combines the power of machine learning algorithms, natural language processing techniques, business rules, and robotic process automation to deliver a comprehensive solution for emergency coding services. In addition, ApexEMS can be quickly deployed as a plug-and-play mechanism, with the added bonus that the solution is easy to maintain.

Customers who have integrated ApexEMS into their ARCM processes have reported significant impacts including:

With ambulance coding being such a unique use case, there is a defined need for companies to integrate solutions that are both efficient and cost effective. The rules concerning non-physician provider ambulance codes remain distinct and emergency conditions mandate the services provided by non-physicians to be coded according to the severity of the medical condition itself.

Auto coding solutions like ApexEMS give EMS providers the flexibility and agility of an error-free procedure. Integrating automation into existing workflow and coding process thereby increases efficiency and reduces overall expenses. As a result, EMS providers are able to: