ExdionACE
Enhancing Revenue Integrity for Acute Care Providers

As the health care system evolves to cope with expanding demands in the face of limited resources, acute care centers are witnessing a huge influx of patients. Since the onset of the pandemic, the burgeoning volume of patients has multiplied the challenges that they face in optimizing their coding workflows. In such a scenario, urgent care centers (UCCs) and other acute care providers across the country are leaving thousands of dollars on the table due to faulty medical coding. Medical coders have traditionally been managing coding and billing manually—a time-consuming process that lacks scalability and is prone to errors. Even minor billing and coding mistakes can lead to claim denials, loss of revenue, fines and penalties, and even impact the patient experience. At the same time, clinics are facing a deficit of experienced coders and struggling to implement technology to augment the service delivery with existing staff. So, how can practices manage the many intricacies of medical billing and coding to stay profitable?

The answer lies in automated medical coding, and this is where ExdionACE excels. Novel technology applications using artificial intelligence (AI,) machine learning (ML,) and cloud can alleviate the pains of acute-care providers, help them efficiently manage revenue realization, and stay profitable to serve their communities. To this end, ExdionACE is built as an advanced, AI-powered auto coding, revenue integrity, and CDI (Clinical Documentation Improvement) platform to help increase revenue and ensure compliance. “UCCs are unique given that they are different from the typical family practice on one end of the spectrum and the ER on the other end. Finding experienced physicians, coders, and other staff is always difficult,” says Dan Narayan, VP, Sales, ExdionRCM. ExdionACE was created by clinical and RCM experts as a revenue integrity solution through automated coding and CDI.

Smart medical coding solutions can enable faster turnaround times, efficiency, and cost-effectiveness for all providers.

“As a coding powerhouse, ExdionACE is built leveraging years of industry expertise, which has been codified into a hyper-intelligent AI-driven platform. Built on a proprietary, AI engine, ExdionACE automatically scans encounters and flags possible compliance gaps, processes and manages a huge volume of charts in minutes, identifies under-billed and over-billed services, or even services that are not billed, and allows healthcare providers to uncover potential revenue opportunities,” states Narayan. ExdionACE incorporates MDM (medical decision making) for E/M (evaluation and management) coding, enabling practices to manage the current 2021 E/M coding changes.

While billing scrubbers can only identify billing errors, ExdionACE’s AI focuses on the relationship between the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes. ExdionACE can easily integrate with healthcare providers’ EHR as well as practice management systems using APIs. The solution is packaged into three robust applications—Auto Coding, Revenue Integrity & Compliance, and Computer-Aided Provider Documentation (CAPD) with CDI.

ExdionACE has been successfully utilized by several UCCs, including CareXpress, a chain of five urgent care clinics owned by Family Medicine Centers located in and around Amarillo, Texas, and American Family Care (AFC) UCC in Memphis, Tennessee. In fact, ExdionACE had identified over $44,000 in lost revenue for AFC due to E/M code and other issues, which was about 25 percent of the practice’s total monthly revenue. Over the past six months, ExdionACE has helped AFC drastically reduce lost revenue and realize better collections.

ExdionRCM has carved a unique niche for itself in the market, providing quality revenue cycle management and coding services for over ten years. “Our biggest differentiator is the ability to blend our end-to-end spectrum of services and deep domain knowledge with cutting-edge technologies. Our commitment through all stages of transformation is what makes us a trusted partner,” notes Narayan.

As an innovation-led enterprise, ExdionRCM has been continuously investing in new technologies. ExdionRCM is actively working with cutting-edge Natural Language Processing (NLP) algorithms and a host of other technologies to deliver better value across the provider revenue cycle.