The Automated Revenue Integrity Solution

Expressly for Urgent Care Centers, Walk-in Clinics and Primary Care Physicians

ExdionCA

ExdionRCM provides Revenue Integrity automation for Urgent Care Centers, Walk-in Clinics and Family Physician offices.

Created by clinical experts for acute care leaders.

Introducing ExdionCA, an advanced automated CDI solution designed to conform compliance and increase revenue.

ExdionCA automated CDI is built on a proprietary, rules-based engine that automatically scans and flags encounters with possible gaps, enabling providers to stay compliant while maximizing legitimate reimbursement.

ExdionCA delivers revenue integrity through two robust applications — pre-bill code validation and post-bill code audit – to:

  • Improve provider accuracy
  • Standardize care across the practice
  • Reduce manual labor and billing errors
  • Reduce denials and claim resubmissions
  • Capture missed charges
  • Confirm compliance

Acute Care centers benefit by being able to identify potential billing errors such as:

  • Under-billed services
  • Over-billed services
  • Up-coding: Denied or Down-coded Services
  • Services not billed (missed charges)

ExdionCA has helped acute care centers validate existing processes, drive provider education and ensure optimal collections.

Call (469) 277-8184 to learn more about using AI for healthcare revenue integrity

ExdionCA Coding Automation Platform Case Study

About Client

The client (Ideal Urgent Care) is a locally owned and operated Urgent Care with three locations in Dallas. The center is rapidly expanding with plans to open two additional centers within the next six months. Each location season averages about 40 patients per day. With the rapid expansion and increase in patient visits, the center wanted to establish a strong process for compliance and ensure effective revenue management.

Challenge

While growth was very important to Ideal Urgent Care, compliance was becoming a priority. Ideal Urgent Care wanted to ensure compliance with Federal regulations such as insufficient documentation, medical necessity, and correct ICD-10 diagnosis coding. With three locations and two more expected, Ideal Urgent Care wanted to ensure robust documentation and coding practices to drive improved revenue and collections. They were looking for a solution that can help assess their current levels of compliance and identify gaps in practices resulting in revenue leakage.

Solution 

ExdionRCM proposed a focused audit and deployed the ExdionCA Coding Automation platform. The Coding Automation platform is a powerful tool that allows Urgent Care Centers like Ideal Urgent Care to validate their existing practices, drive provider education and ensure optimal collections. ExdionCA is built on a proprietary rules engine created by Urgent Care experts. The platform rapidly skims through large sets of encounters to identify potential issues and helps build necessary control measures. Urgent Care centers benefit by being able to identify potential billing errors such as:

  • Under-billed services
  • Over-billed services-frequency
  • Up-coding
  • Denied or Down-coded Services
  • Services not billed (missed charges)

Specifically for Ideal Urgent Care, Exdion’s expert certified Urgent Care coders further analyzed and built provider and nurse training programs to assist with documentation compliance. Urgent Care centers can also choose to just use the platform for a nominal per chart fee. ExdionCA enables standardization of care, improved provider performance resulting in compliance, higher patient satisfaction and revenue.

Impact

Ideal Urgent Care used ExdionCA coding automation on a set of 2000 random charts. A report with the submitted codes was issued for the 2000 charts, and access to the charts was granted.The findings provided some deep insights into the documentation and coding practices – money was being left on the table and potential compliance issues were going unaddressed.

  • 85% of the flagged charts(~1100) had missing Injury related codes. These included treatments as well as supply codes.
  • 70% of the charts (~900) had low level codes or missing E/M codes.
  • 50% of the charts (~650) had Missing Injection or immunization related codes.
  • 25% of the charts (~325) had multiple missing codes such as blood draw when labs were performed.
Revenue-Integrity-chart

Ideal Urgent Care management team was able to review and re-bill majority of the claims and had increased their revenue for the claims by roughly 57% or $141,000.

Contact us

Want to know more? Contact us today for a free trial of the revenue integrity solution developed expressly for acute care centers.