Emergency Department Coding & Billing Services

ApexonHealth has 15+ years of experience in serving ED Organizations. Our solutions and services are built to cater the ED professional and Facility coding and billing needs. Our solutions will maximize profitability of your ED RCM operations.

Newton AI Automation Solutions

Our solutions will maximize profitability of your ED RCM operations. Our ED Coding & Billing teams are supported by our AI driven RPA solutions customized to provide you long-term benefits.

Years supporting ED RCM

ED visits managed per year

ED Bots deployed

ED experienced employees

ED specific AI solutions

 

ApexonHealth over the last 4 years has been an early pioneer/investor in ED specific AI solutions. These solutions have been implemented for multiple ED customers. Key benefits include:

 

  • Consistently achieve higher acuity levels (70%+) than national MGMA standards (56%)
  • Consistently achieve higher acuity levels (70%+) than national MGMA standards (56%)
  • 8%+ higher reimbursement compared to national standards
  • OIG Compliant and mathematically proven sampling techniques

We are consistently achieving the above by increasing the performance of experienced ED RCM operations team. Some of the advanced solutions that create sustainable revenue and margins for all stake holders include:

  • AI driven assisted coding (customized for each customer)
  • AI driven assisted coding (customized for each customer)
  • Machine learning driven error prediction models (customized for your operating environment)
  • Advance BI reporting including Anomaly detection, revenue leakage, RVU, CDI, revenue forecasting etc.
  • Loss prediction models
  • Intelligent workflow (integrating above components)
  • Experienced ED RCM operations and audit teams.

Solution Benefits

Acuity shift analysis

Productivity improvement by upto 40%

Denial reduction by 25%

Medical Necessity accuracy at 95%

Physician productivity measured to accurate

CDI issues reduced by 50%

Accurate Bonus calculation

Increase in revenue by 1 to 2%

Solution Features

ED Full Cycle RCM Services
  • Eligibility Valdiation
  • Expert coding services
  • Charge Entry & claim submission
  • AR Follow-up
  • Payment Posting

Newton AI ED Solutions
  • Eligibility automation
  • ED Assisted coding solution
  • Charge Entry Automation
  • Error Prediction
  • AR Automation
  • Payment Posting Automation
  • QA Audit solutions

SensER Reporting & Actionable insights
  • Operational Reports
  • Revenue Cycle Financials
  • Provider Productivity Room Reports
  • Emergency Room Operations
  • Identification of Anomalous Providers
  • Revenue Forecasting

Seamlessly integrate our Newton AI Automation Tools & RPA BOTs to boost your revenue

Newton AI Assisted-Coding tool

Uses our ED/UC AI-assisted coding platform that integrates Machine learning, Natural Language Processing(NLP) and Robotic Process Automation(RPA) to automate medical coding. Our coding solution ingests PDF chart, EMR data and also other formats to extract the necessary data for assisted-coding and error prediction, accounts for ‘Critical to Quality Fields’ and generates the automated results for LOS, CPT, ICD, MIPS and Modifiers along with probable reasons and validates medical necessity. In Real-time audit process the efficiency increases by allowing the team to focus on the most critical charts while drastically reducing your overall coding costs.

Error Prediction tool

This AI-based advanced predictive algorithm touches all charts predicting the erroneously coded chart and generating audit samples; it works equally well on manually or auto coded charts. It validates correctness of coding and utilises RAT stat models for random sampling. Besides following an OIG stipulated methodology, it also gives recommendations for auditors and helps them prioritise the charts based on anitcipated dollar loss.

ED/UC Quality Audit Models(QA)

Our ED/UC QA models primerly follow three stage quality control process where it starts with establishing of current error rates by randomly picking-up sample claims for a statistically significant volume and audit them to establish benchmark accuracy. At second stage Erroneous claims are picked using various techniquies like Best fit classification model, Loss Recovery Model & OIG Compliance Algorithm, etc. Finally through manual audit we establish audit volumes to achive required SLA and manage focused trip audits.

Billing Automation

We use Robotic Process Automation to automate billing process such as Eligibility check, Charge Entry, Payment posting & Remit which reduces mannual billing errors and helps improved compliance standards.

AR Bots & Touch Analytics

AR Bots consists of automated modules of Aging(ATB) Analysis, Work Queue Prioritization, Auto Analysis & Claims Status and take actions based on updated status. Our AR bots with predective moduling helps follow-ups on A/R aging and update the status. This deep learning algorthim coupled with ED/UC speciality driven BI tools enables us to provide insights to Claims touch efficiencies, AR allocation avoidance, and outstanding collectibles.

SensER

Provides next-generation advanced analytics to deliver actionable intelligence for ER leaders. SensER aggregates data from multiple transaction systems – revenue cycle management, the hospital’s transaction system, physicians calendar and patient data, and other available sources, to derive critical Operational, Financial, Clinical Key Performance Indicators (KPIs) and creates analytical models. Such deep and detailed analysis of the organizational performance helps physicians improve the overall quality and cost of delivering care.

 

Emergency Department Coding & Billing Services Case Study

Talk to our 

Business Consultant

Ph: 1-866-846-3329

Email: info@apexonhealth.com

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