Missing revenue opportunities (that no other coding solution can find): The platform uses AI to recognize such encounters and flags them off for review. On average, we have been able to deliver about 18% in increased revenue for practices that work with us.
Identify Compliance gaps: Given the highly scalable AI architecture, every chart is audited to assess documentation gaps, upcoding, and downcoding possibilities. We have been actively helping many of our clients prevent and prepare for audits. Technology is simply more accurate, faster, and cheaper.
CDI improvement: Automated provider querying/communication isolates specific learning areas, trickling down for the effective adoption of documentation improvements.
Auto Coding: The technology eliminates the need for coders on staff and helps clinics redirect this bandwidth to more critical patient management functions.
Reporting & Analytics: Powerful dashboards that provide actionable insights into acuity intelligence, revenue performance, provider training needs, and much more. Here is a link to how we are different from other solutions.
For more information about how ExdionACE can auto code your charts, enhance revenue, and improve documentation compliance in your organization, contact Dan Narayan at dan_n@exdion.com or 469-277-8184 (O).
By: Larry Earl, MD & Ira Pasternack
Artificial intelligence (AI) is rapidly changing the way we approach evaluation and management (E&M) coding. AI is being used to improve the accuracy and speed of E&M coding, making it easier for healthcare providers to accurately document patient encounters and receive payment for their services. AI-based technology is helping healthcare providers identify valid codes more quickly, reducing the time and effort required to complete E&M coding tasks. By automating the process of E&M coding, AI is helping healthcare providers to focus on providing quality care, rather than spending time on tedious coding tasks. AI is also improving the accuracy of E&M coding, ensuring that claims are correctly coded and paid correctly. By leveraging the power of AI, healthcare providers can save time, money, and resources while providing the highest quality care to their patients.
What is artificial intelligence?
Artificial intelligence (AI) is a computer system that mimics human cognitive functions in order to solve complex problems. AI systems may be able to learn from previous data and make predictions from that data. When AI is applied to healthcare, it can help physicians make faster diagnoses, lead to more accurate health outcomes, and improve cost- efficiency. Artificial intelligence is used in a variety of healthcare settings and applications, including computer vision, natural language processing, and machine learning. Computer vision is used in healthcare to identify and diagnose diseases based on visual images, such as x-rays, CT scans, and MRIs. Natural language processing is used for computers to interpret, understand, and generate human language, such as physician notes and patient reports. Machine learning is used when a computer system learns, grows, and changes with new information and data.
How is AI improving evaluation and management (E&M) coding?
AI is being applied to the E&M coding process to improve accuracy, reduce coding errors, and speed up the whole process. AI systems are able to analyze tens of thousands of pieces of data, such as ICD-10 codes and CPT Codes, quickly and thoroughly. This allows AI to identify and flag potential errors, gaps, and omissions in E&M documentation, improving the accuracy and quality of E&M coding. AI is also able to analyze every chart document every night, allowing it to flag potential errors and inconsistencies. This is then queried back to the healthcare providers who may not have had the time to analyze all of their data at once. AI can help providers to continuously monitor and improve their E&M coding process.
AI’s impact on coding accuracy
Accuracy is key in any industry, especially healthcare. The stakes are high, and inaccurate E&M coding can have serious adverse effects for patients and providers alike. Previous research has found that between 10 and 20 percent of coding may be incorrect. E&M codes are the most common type of coding, and they can be challenging to assess and code accurately. AI is able to analyze thousands of data points to arrive at accurate E&M coding decisions. While humans are also capable of this, computers can process and analyze data far more quickly than humans. AI systems can also use algorithms to identify patterns and trends that would take a human much longer to identify. This allows AI to code accurately in a fraction of the time it would take a human.
AI’s role in improving patient care
Accurate E&M coding can improve patient care by allowing healthcare providers to be reimbursed for the services they provide. If providers are not being reimbursed for necessary services, it can be difficult for them to provide high-quality care to their patients. AI can help providers to quickly and accurately code E&M documentation, improving their chances of receiving payment for their services. AI can also improve the efficiency of the E&M coding process, allowing providers to spend less time on tedious E&M coding tasks.
This can free up time for healthcare providers to spend more time with their patients. AI is also able to identify patterns and trends in E&M documentation, which can help providers to identify problem areas in their documentation. This can help providers to improve the quality of their documentation and ensure that they are not missing any information.
Examples of AI-based E&M coding solutions
- Automated E&M coding: Automated E&M coding is one example of AI being applied to the E&M coding process. Automated E&M coding uses a combination of natural language processing, machine learning, and computer vision to identify and code E&M documentation. With automated E&M coding, providers enter their documentation into a software application, and the AI system extracts the data and codes from that documentation. Automated E&M coding is a good fit for providers who have consistent documentation and don’t frequently change their coding strategies. It is also a good fit for providers who have ample time and resources for training the AI system.
- Automated coding assist: Automated coding assist is a coding solution that leverages AI to help providers identify appropriate E&M codes. With automated coding assist, providers enter E&M documentation into a software application. The software application analyzes the documentation, flags potential errors, and provides recommendations for appropriate E&M codes. Automated coding assist is helpful for providers who have inconsistent documentation and who frequently change their coding strategies. It is also helpful for providers who have limited time and resources for training the AI system.
- Expert E&M coding: Expert E&M coding is a coding solution that uses an AI system to emulate a human coder. Expert E&M coding systems use machine learning to identify and code E&M documentation. Expert E&M coding systems are usually paired with a human coder to make sure that the AI system is consistent. Expert E&M coding systems are a good fit for providers who have highly consistent documentation.
The Exdion Solution
ExdionACE is an Expert coding system going beyond E&M to a fully automated coding solution. The solution includes the ability to identify and capture missed revenue opportunities through coding optimization, while ensuring compliance. This includes analyzing medical records and claims data to identify any potential coding errors or omissions. It also provides clinical decision support, enabling providers to make more accurate decisions in regards to coding and reimbursement.
The system can identify potential areas of improvement by comparing a provider’s current coding practices against industry-standard guidelines. It can also help detect fraud and abuse, as well as assist with code validation and compliance reviews.
Every chart is audited by the system every night, generating flags for possible coding improvements. ExdionACE starts by going beyond the traditional code scrubbing to identify potential issues and pre-empt potential denials.
Next is the identification of straightforward missed revenue by the Clinic due to a lack of coding guidelines as per the documentation given by the provider. The system then creates “flags” that generate a query to the provider regarding potential loss due to lack of, and opportunity to improve, the documentation. Once a response is received from the provider, the documentation is updated, and the resulting coding enhancements are sent on to the billing team.
Robotic Process Automation (RPA) allows Exdion to work with any EHR and existing billing systems or services. Clients can enhance collected revenues by up to 25%, reduce denials, speed reimbursement, and improve documentation compliance.
Benefits of ExdionACE
Missing revenue opportunities (that no other coding solution can find): The platform uses AI to recognize such encounters and flags them off for review. On average, we have been able to deliver about 18% in increased revenue for practices that work with us.
Identify Compliance gaps: Given the highly scalable AI architecture, every chart is audited to assess documentation gaps, upcoding, and downcoding possibilities. We have been actively helping many of our clients prevent and prepare for audits. Technology is simply more accurate, faster, and cheaper.
CDI improvement: Automated provider querying/communication isolates specific learning areas, trickling down for the effective adoption of documentation improvements.
Auto Coding: The technology eliminates the need for coders on staff and helps clinics redirect this bandwidth to more critical patient management functions.
Reporting & Analytics: Powerful dashboards that provide actionable insights into acuity intelligence, revenue performance, provider training needs, and much more. Here is a link to how we are different from other solutions.
For more information about how ExdionACE can auto code your charts, enhance revenue, and improve documentation compliance in your organization, contact Dan Narayan at dan_n@exdion.com or 469-277-8184 (O).
