Meet the Client

A regional health system with a busy outpatient network, including urgent care, family medicine, and pediatrics, was managing roughly 2,200 monthly claims. With recent staffing changes and growing patient volume, leadership sought a sustainable way to maintain coding accuracy, accelerate reimbursement, and reduce dependence on manual work.

The CEO and RCM Director were especially interested in exploring AI-enabled autonomous coding to stabilize operations and improve revenue predictability.

The Challenge: Coding Gaps That Cost Time and Revenue

As the system’s urgent care centers grew busier, manual workflows revealed hidden vulnerabilities:

• Staff turnover led to inconsistent code selection and delayed charge posting.
  
  
• Procedures and tests, such as rapid flu, strep, and COVID testing, were often missed or miscoded.
  
  
• Modifier usage varied by provider, increasing bundling denials and compliance risk.
  
  
• Injection and vaccine administration codes were frequently overlooked.
  
  
• Charge lag stretched beyond four days, straining cash flow.
  
  

These gaps eroded revenue integrity and increased coder workload at a time when leadership needed operational stability.

The Solution: Ember’s Autonomous Coding Engine

Ember was introduced to eliminate variability and improve claim readiness at the source. By analyzing clinical documentation in real time and automatically assigning accurate CPT, ICD-10, and modifier combinations, Ember ensured every encounter was coded consistently and compliantly without adding administrative burden.

Key capabilities included:

• Automatic detection of procedures, tests, and injections.
  
  
• Smart modifier logic for visits that included E/M and procedures.
  
  
• Vaccine and immunization intelligence to capture administration and counseling codes.
  
  
• Seamless integration with the existing EHR for clean, audit-ready claims.
  
  

The Impact: Accuracy, Speed, and Confidence

Within three months, the urgent care team saw measurable gains:

• 21% reduction in denials, primarily from correct modifier and procedure coding.
  
  
• Charge lag reduced from 4.5 days to under 0.5 days.
  
  
• Coding costs decreased by 38%, freeing staff for higher-value RCM work.
  
  
• Over 93% of encounters coded autonomously, virtually eliminating backlog.
  
  

Providers and leadership alike reported greater confidence in billing accuracy and payer relationships.

“We’re finally proactive instead of reactive. Ember ensures our codes are right the first time, no chasing, no rework.”

Looking Ahead

Building on the urgent care success, the organization plans to expand Ember across family medicine and pediatrics. The next phase focuses on real-time documentation feedback and preventive service optimization to capture full revenue and maintain compliance as the system scales.

“Ember gives us speed and consistency we can trust. It’s changed how we think about coding and revenue integrity.”