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How Carexpress increased business revenue by 40% using Exdion Health AI Driven Coding Engine

A recent whitepaper published by Exdion Health, on Urgent care Buyers Guide mentions how many physicians saw a steep drop in patient walk-ins during the early days of the pandemic. Urgent care practices, long touted as alternatives to hospital emergency rooms, were most affected as they do not have a regular roster of returning patients. They were also not equipped to quickly make a transition to telemedicine services. That forced them initially into performing high volumes of COVID-19 tests and then vaccine distribution, which helped provide a temporary fix to their finances in an attempt to stay open.

Today, as COVID-19 moves from a pandemic in the U.S. to an endemic, medical practices have to grapple with changes that will remain for the long-term. That not only includes the use of telemedicine, but also identifying patients who may have “long COVID” or other associated medical issues simply rebuilding their practices to what they were prior to the pandemic.

Urgent Care Centers

Urgent Care Centers - Exdion Health

One thing medical practice can do immediately is to address deficient medical coding and billing. This can be particularly crucial for smaller practices in niche parts of medicine, such as urgent care clinics.

Deficient coding leads to money being left on the table by medical practices, a sum that reaches billions of dollars a year in the U.S. There are a variety of reasons why deficient coding occurs. Salient among them are:

  • Doctors who see numerous patients in a short period may get distracted, leading them to forget charting notes.
  • When chart notes are taken, they’re written in a way that doesn’t take specific codes into account.
  • Doctors and other clinicians may not be aware that a single procedure–such as putting a cast on a patient’s arm–can include multiple codes and modifiers.
  • Concerns among providers that overly aggressive coding may trigger an audit by an insurer or recovery audit contractors (RACs), prompting them to be overly conservative when coding.
  • Multiply these issues by 20 or 30 patient encounters per day with deficient coding the clinicians can lose a significant amount of potential revenue.
  • Medical coding is extremely fluid and are often changed by the American Medical Association (AMA), which oversees much of the U.S. coding protocols for medical practices. In 2021, the AMA ushered in some fundamental changes in coding for Evaluation and Management (E/M) – the backbone to any initial patient encounter. In 2020 alone it made changes to more than a dozen codes (CPT 99202-99215).

The AMA’s intent behind the coding changes is to provide more clarity regarding reporting whether a test was considered rather than ordered; what constituted a discussion between physicians, other healthcare professionals and patients; and how test results are analyzed, among other changes. They stressed the importance that physicians and clinicians should place on recognizing all patient problems whether they are acute or chronic document them in more specific detail.

Urgent Care Centers were struggling with these coding changes when COVID-19 struck.

Given that most urgent care practices tend to be small operations with just a handful of doctors and support staff at each location, many did not have the resources to take one major hit to their bottom lines, let alone two.

Medical Coding

Medical Invoice - Exdion Health

Urgent care centers operating outside of large cities have trouble recruiting enough coders, which can be key to optimizing both coding and billing practices. And there is a general shortage of healthcare workers.

CareXPress, which operates five urgent care centers in and around Amarillo, Texas, was hit hard by both issues.

In a news published by Business wire, CareXpress Chief Financial Officer Trent Limb said, “There was a good bit of revenue that was being left on the table”. That issue was being further exacerbated by the COVID-19 pandemic.

“We needed more coders and we couldn’t hire more coders,” Limb said. “We needed to look for an outsourcing solution just to be able to deal with the volume of coding we needed to do just to keep up with billing.”

Imagine a platform that can Increase revenues for most medical practices without audit risk. A new AI-driven optimization platform developed by Exdion Solutions is pioneering new ways for medical practices to optimize coding and increase revenue.

L.S. Ram, Chief Executive Officer - Exdion

L.S. Ram, Chief Executive Officer – Exdion

“The use of electronic medical records has been perhaps the biggest advance in healthcare delivery in the past 25 years and a crucial tool in ensuring patient safety,” said L.S. Ram, Exdion’s Chief Executive Officer. “Now, as computing power has grown in leaps and bounds and has led to the development of rules-based learning and AI, the EMR may now be used for the financial safety of medical practices.”

Technology – particularly cloud-based Artificial Intelligence (AI) and complex rules-based decision platforms – are now being leveraged by providers to keep their medical practices open. Exdion Health is leading the way through AI-led innovations, particularly in the critical urgent care space.

Exdion Health

The Exdion Health Platform revolutionizes the use of Artificial Intelligence in Medical Coding. It interfaces with a medical practice’s EMR systems either through an automatic process using bots, or through various application programming interfaces (APIs).

Before the platform is fully deployed, it will analyze about 100 recent patient encounters to determine how each medical practice approaches coding. Thereafter, the practice is informed on how to make changes in order to improve their overall performance. All recommendations are compliant with state and federal guidelines.

To overcome their Medical Coding and Revenue Integrity challenges, CareXPress turned to Exdion Health, pioneers of the all-in-one platform; Exdion Health.

Exdion Health is a Computer Aided Provider Documentation (CAPD), Revenue Integrity, Compliance and CDI platform, exclusively for the urgent care center. The Artificial Intelligence (AI) platform helps capture accurate, complete and compliant code relationships (ICD/CPT) according to typical Standard of Care. It instantly recognizes physician documentation improvement areas while considering clinical decision-making, missing codes, E&M levels, modifier usage and much more. It can operate as a standalone application or can easily be integrated with the practice’s electronic health records (EHR) systems.

Exdion Health can analyze thousands of patient encounters within a few minutes and flag them for possible coding, revenue and compliance gaps.

In the case of CareXPress, Exdion Health instantly concluded that 18% of all its patient encounters were being insufficiently coded. The adjustments translated to a 40% increase in revenue from more accurate Evaluation and Management (E&M) coding alone.

Prior to retaining Exdion Health, the average claim per patient per visit by CareXpress was $320. That rose to $375 per visit within 90 days of retaining Exdion Health to review billing and coding. Limb expects that number to continue to rise in the coming months.

About Exdion Solutions

Exdion Health, a part of Exdion Solutions is a global health-tech firm helping medical practices prepare for the digital tomorrow. Its technology solutions transform revenue cycles through AI, data science and automation. Exdion Health was recognized as a Top 10 Healthcare Workflow Solution Providers by Healthcare Tech Outlook in 2021. As a medical coding powerhouse, the company services numerous medical practices through its flagship platform Exdion Health.

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