Medical coding is one of the most in-demand technical professions in the healthcare field. In regions such as the Texas panhandle, medical coders are particularly hard to recruit and retain.
The coder shortage was putting significant pressure on CareXpress, a chain of five urgent care clinics owned by Family Medicine Centers located in and around Amarillo, Texas. Its staff of physicians and other medical professionals is devoted to providing the best patient care. But like many urgent care centers, it is not necessarily focused on optimizing its use of medical codes for billing and efficiency. In addition, the shortage of coders decreased the ability to follow up with providers regarding open patient charts, increasing the lag time in claims being processed and paid.
As a result, CareXpress may have missed out on billing for procedures that were conducted by its medical staff. “There was a good bit of revenue that was being left on the table,” said CareXpress Chief Financial Officer Trent Limb. That issue was being further exacerbated by the COVID-19 pandemic. “We needed to look for a solution to deal with the volume of coding we needed to do just to keep up with billing,” Limb said.
In mid-2020, Family Medicine Centers contracted with ExdionRCM, a branch of Exdion Solutions. The company quickly began analyzing the coding practices of the CareXpress centers using its ExdionCA advanced revenue integrity solution driven by artificial intelligence. ExdionCA operates on a proprietary engine that automatically scrutinizes and flags encounters with possible gaps based on standard of care. Its customizable platform and quick implementation are designed for urgent care centers and other clinics to validate existing processes and correct issues such as inaccurate documentation in free text, missed procedure documentation and much more according to industry standards and their experience with urgent care centers.
ExdionCA immediately pinpointed numerous areas where revenue opportunities had been overlooked. As a result, it concluded that 18% of all of CareXpress’ patient encounters were being under-coded. The adjustments translated to a 40% increase in revenue from more accurate Evaluation and Management (E&M) coding alone.
“In a historically tight labor market, urgent care centers do not need to divert their business focus to finding individual medical coders. There is an automated solution, and we can provide it,” said Exdion Solutions VP Sales Dan Narayan.
About Exdion Solutions
Exdion Solutions is a global firm helping providers prepare for digital operations and 24/7 customer engagement. Its technology-led solutions deliver transformational excellence through strategic levers that include consulting, robotic process automation, artificial intelligence and data science products. ExdionCA is recognized as “One of the Top 10 Healthcare Workflow Solution Providers 2021” by the publication Healthcare Tech Outlook. For more information, visit www.exdionrcm.com.