Urgent Care(UC) Coding & Billing Services
ApexonHealth has 15+ years of experience in serving Urgent Care Organizations. Our solutions and services are built to cater to the Urgent Care Centers’ coding and billing needs.
Newton AI Automation solutions
Our solutions will maximize the profitability of your Urgent Care Centers operations. Our Urgent Care Center Operations teams are supported by our AI-driven RPA solutions customized to provide you long-term benefits.
Years Supporting UC RCM Organizations
Visits Managed Per Year
UC Bots Deployed
UC Experienced Employees
Urgent care specific AI solutions
ApexonHealth, over the last four years, has been an early pioneer/investor in UC-specific AI solutions. We have implemented for multiple UC Centers. Key benefits include:
- Consistently achieve higher acuity levels (70%+) than national MGMA standards (56%)
- 6%+ higher reimbursement compared to national standards
- OIG Compliant and mathematically proven sampling techniques
We are consistently achieving the above by increasing the performance of the experienced UC RCM operations team. Some of the advanced solutions that create sustainable revenue and margins for all stakeholders include:
- AI-driven assisted coding (customized for each customer)
- Machine learning-driven denial prediction models (customized for your operating environment)
- Advance BI reporting, including Physician productivity, revenue leakage, CDI, revenue forecasting, etc.
- Loss prediction models
- Intelligent workflow (integrating above components)
- Experienced UC RCM operations and audit teams
Error Prediction Tool
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%
UC Full Cycle RCM Services
- Eligibility Valdiation
- Expert coding services
- Charge Entry & claim submission
- AR Follow-up
- Payment Posting
Newton AI Solutions
- Eligibility automation
- UC Assisted coding solution
- Charge Entry Automation
- Denial Prediction
- AR Automation
- Payment Posting Automation
- QA Audit solutions
- CDI Solutions
Reporting & Actionable insights
- Provider Productivity Room Reports
- UC Center Operations
- Operational Reports
- Revenue Cycle Financials
- 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 data required 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 the 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 the correctness of coding and utilizes RAT stat models for random sampling. Besides following an OIG stipulated methodology, it also gives auditors recommendations and prioritizes the charts based on anticipated dollar loss.
ED/UC Quality Audit Models(QA)
Our ED/UC QA models primarily follow a three-stage quality control process. It starts with establishing current error rates by randomly picking-up sample claims for a statistically significant volume and auditing them to establish benchmark accuracy. Erroneous claims are picked in the second stage using various techniques like Best fit classification model, Loss Recovery Model & OIG Compliance Algorithm, etc. Finally, we establish audit volumes to achieve the required SLA and manage focused trip audits through a manual audit.
We use Robotic Process Automation to automate billing process such as Eligibility check, Charge Entry, Payment posting & Remit, which reduces manual billing errors and helps improved compliance standards
AR Bots & Touch Analytics
AR Bots consists of automated Aging (ATB) Analysis, Work Queue Prioritization, Auto Analysis & Claims Status, and take actions based on updated status. Our AR bots with predictive modeling help follow-ups on A/R aging and update the status. This deep learning algorithm coupled with ED/UC specialty-driven BI tools enables us to provide insights to Claims touch efficiencies, AR allocation avoidance, and outstanding collectibles.
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, physician’ s calendar, patient data, and other available sources, to derive critical Operational, Financial, Clinical Key Performance Indicators (KPIs) and creates analytical models. Such in-depth and detailed analysis of the organizational performance helps physicians improve the overall quality and cost of delivering care.
Urgent Care Coding & Billing Services Case Study