Improving Financial Outcomes for FQHCs with AI-Powered Coding
Revedy's platform addresses the unique coding and billing complexities that Federally Qualified Health Centers face. We help you improve revenue integrity, ensure compliance, and reduce the administrative burden on your team.
How Revedy AI Improves FQHC Outcomes
Maximize Reimbursement for Integrated Care
Incorrectly coded same-day medical and behavioral health visits are a primary source of lost revenue. Our AI engine analyzes clinical documentation to ensure every billable service is captured and correctly coded.
- Automated Modifier Application: Identifies scenarios requiring modifiers (e.g., 25, 59) and applies them to ensure separate billing for integrated services.
- Documentation Analysis: Scans clinical notes to identify all billable encounters, preventing missed revenue opportunities.
- Payer Rule Enforcement: Validates coding against specific payer policies for same-day billing, increasing the clean claim rate.
Increase Revenue Capture from Wrap-Around Payments
Manually reconciling MCO payments against PPS rates is time-consuming and error-prone. Revedy provides the intelligence to streamline this process, ensuring you can claim the full wrap-around amount you are entitled to.
- AI-Driven Data Extraction: Intelligently extracts payment data from MCO remittance files and cross-references it with your PPS rate sheets.
- Reconciliation Support: Consolidates the necessary data points, providing your finance team with the precise, auditable information needed to prepare accurate wrap-around claims.
- Audit Trail Creation: Generates a clear, documented trail of the data used for reconciliation, simplifying any future audits.
Reduce Denial Rates and Accelerate Appeals
Our platform acts as a powerful pre-submission code scrubber and a post-denial analysis engine, shifting your team from reactive denial management to proactive denial prevention.
- Pre-Submission Claim Scrubbing: Validates claims against NCCI Edits, Excludes1/Excludes2 notes, and carrier-specific rules to prevent common denials.
- Automated Denial Analysis: Ingests and analyzes payer denial documents to instantly identify the root cause and reasoning.
- Evidence-Based Appeal Generation: Automatically drafts comprehensive appeal letters with supporting clinical evidence and policy citations, reducing appeal preparation time significantly.
Key Business Impacts
Improved Clean Claim Rate
By ensuring claims are compliant with payer-specific coding and modifier rules before submission.
Increased Net Collection Rate
By capturing all entitled revenue from complex FQHC billing scenarios like integrated care and wrap-around payments.
Accelerated Appeals Process
By reducing the manual effort required to fight denials with AI-generated analysis and appeal letters.
Enhanced Staff Productivity
By automating repetitive coding validation and denial analysis, freeing up your team for high-value tasks.