AI Technology Integration:
1. CPT Optimizer
Description: This feature uses generative AI to double-check clinical notes and CPT codes for completeness, identifying any potential CPT codes that may have been missed before submission. It cross-references submitted codes with patient notes and medical histories, ensuring a thorough alignment of the documented services with the coded services.
Customer Advantage: Traditionally, ensuring accuracy in CPT coding is a manual, labor-intensive process that often relies on human judgment, making it prone to errors or omissions. CPT Optimizer automates this verification, reducing the risk of missed billable services, ultimately leading to fewer lost revenue opportunities. It also minimizes the time coders spend on audits, freeing them up for more complex cases and driving efficiency in the billing cycle.
2. ClaimGuard
Description: This feature acts as a last line of defense before claim submission, using AI to validate every aspect of the claim. It checks for common submission errors, incorrect patient data, invalid codes, and any potential compliance issues that might result in denials.
Customer Advantage: Traditional methods rely on manual pre-submission checks or rule-based software, which can miss nuanced errors or fail to adapt to the latest regulations. ClaimGuard offers a more adaptable and accurate solution by leveraging AI’s ability to learn from previous errors and denials. This ensures cleaner submissions, reducing the likelihood of rejections, improving cash flow, and cutting down on time spent revising and resubmitting claims.
3. AppealPro
Description: By analyzing historic denial data and success rates from previous appeals, this feature uses AI to provide strategic guidance on how to handle denied claims. It suggests the best approach for specific denials, such as reclassification of codes or additional documentation needs, based on similar past cases and outcomes.
Customer Advantage: Traditionally, RCM teams rely on experience and intuition when deciding how to appeal denied claims, which can be inconsistent and time-consuming. "AppealPro" offers a data-driven approach, increasing the likelihood of successful appeals and faster resolutions. This results in more recovered revenue, less time spent on appeals, and a smoother overall billing process.