BSHCM, CPC, CPB, Associate VP at ExdionRCM Solutions
Unlike most practices bleeding out revenue from incorrect or missed codes, AFC Urgent Care in Memphis, Tennessee, has conquered this problem and thankfully enjoys healthy financials today. But two years ago, Medical Director Alice McKee, MD, will tell you the practice was on life support. Although some technology can be intimidating, they adopted an easy-to-use next-generation revenue integrity software that integrated with their existing EHR and practice administration platforms.
Infused with artificial intelligence and machine learning, the solution identifies incorrect and missed codes. Dispelling myths and fears about software, it was onboarded by the vendor, learning to use it was quick and easy, and the return on investment is paying dividends.
The proof is in the pudding, as the old saying goes. A recent monthly audit of insured patient encounters at AFC Urgent Care showed an increase in revenue of 30% by correcting flagged encounters, including missed modifiers and administration codes, which was higher than in more recent months. Looking back at the previous 12 months to March 2021, the clinic recovered revenue percentages totaling 18%. While each patient visit wasn’t necessarily a large amount of money, the sum was substantial.
While today AFC Urgent Care has healthier finances, the picture was bleak during the early days of the COVID-19 pandemic. Although affiliated with a national franchise, AFC Urgent Care in Memphis is independently owned and operated. Like most urgent care practices, the clinic has a small staff of two full-time physicians, one part-time physician, and a small auxiliary of medical assistants, x-ray technicians, and office staff. At the onset of the pandemic, patient traffic took a nosedive. To add more stress, the American Medical Association released the new Office Visits Evaluation and Management (E/M) guidelines for the Current Procedural Terminology (CPT) code set in January 2021, its first major revision of the CPT code in more than 25 years.
The revisions directly impacted outpatient coding, a major business driver for urgent care clinics. Although well intended to provide simplicity and flexibility, the timing couldn’t have been worse. Many coding mistakes were being made. Jim Harper, owner and CEO, and his team took immediate action to examine all avenues towards improving coding and billing functions as well as collections. They analyzed and evaluated staff, processes, and technology. The conclusion was easy: coding was a huge problem.
The solution was easy, too. AFC Urgent Care in Memphis adopted a revenue integrity solution, defined as next generation because it’s infused with artificial intelligence and machine learning – everything is automated. The solution allows the clinic to revisit encounters, and identify and process issues for correction. It also includes features such as intuitive coding, to help them code more accurately.
Naturally, the clinic’s leaders wanted to scrub previous encounters, but they also wanted a proactive solution moving forward. While most billing scrubber software can only identify billing errors, their solution uses artificial intelligence that focuses on the relationship between the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes to identify potentially rendered by inappropriately documented procedures. After scrubbing previous encounters, they gained a solution that is intuitive and proactive, and it is customized. With this automated system, the solution proactively provides codes, including missed billable codes, and removes guesswork to figure out which codes are correct. Importantly, it provides codes based on the clinic’s diagnosis and standard of care, instead of a primarily rule-based system with little to no data learning processes.
You might think a small clinic can’t afford a robust technology platform with artificial intelligence. That’s another myth that needs to be crushed. The clinic’s investment in this solution is not a large, up-front capital investment. It’s capped at a fair amount.
A highly detailed reporting system gives an overall view, but it also provides details that enable the clinic to see encounter information, improve processes, and understand exactly where they recovered revenue. All parties involved have a vested interest in surfacing improvements and recovered revenue.
According to Dr. McKee, the clinic is charting and coding better than ever before – they are no longer missing payments for many of the services they render and seeing a revenue boost of about 25%. Also important and often overlooked, the solution has helped reduce stress and improve efficiencies and compliance.
