Healthcare organisations are shifting towards automation with revenue cycle management to protect operating margins and the increasing claim denials from payors. Every year, nearly $265 billion in claims made by US healthcare organisations are denied. The two major reasons for the denials are the way claims are coded on payor documentation and delayed submissions. Reportedly, coding errors account for over 40% of claim denials, while untimely submissions contribute to 35% of denials. Other reasons such as eligibility and prior authorisation also play a significant role.
Addressing this pain point, New York-headquartered RapidClaims is automating medical coding to help health organisations reduce claim denials from payors. It has emerged from stealth with $3.1 million in seed funding. The investment was led by Together Fund alongside participation from Better Capital, Neon Fund, Peercheque, and DeVC. It also saw participation from angels and advisors coming from prominent US healthcare organisations, including Oscar Benavidez (Executive Director, Mass General), Ankit Jain (Founder & CEO of Infinitus), and Sachin Jain (President & CEO of Scan Health) among others.
RapidClaims plans to tackle the claims denial problem head-on with its medical coding automation module. Having achieved success with six pilots within two months of its beta product launch in June 2023, the company is poised to enhance product robustness even further with an additional five pilots already in the pipeline.
How was the idea born?
RapidClaims was founded in 2023 by Dushyant Mishra who serves as the CEO and led by Jot Sarup Sahni and Abhinay Vyas. The idea for RapidClaims originated in 2018 during Mishra’s tenure at Abbott Healthcare when he observed the challenges faced by hospitals while interacting with multiple hospital owners and physicians. Since then, he has closely monitored the space, which gained significant momentum in 2022 as two key trends emerged – an increase in claim denial rates across the US and the effective demonstration of large language models (LLMs) as a solution to these challenges.
Deploys AI to avoid claims denials
AI holds immense potential for introducing exceptional efficiencies into this domain. Beyond identifying the right code, AI’s current state allows for precise context interpretation, adding a layer of sophistication to the coding process. RapidClaims has unveiled three multi-specialty products as detailed below:
RapidCode: It is a fully autonomous medical coding, streamlining the process with end-to-end automation.
RapidAssist: This is a tailored tool for medical coders designed to improve productivity by auditing charts and identifying documentation gaps, which includes a query builder and rule-set engine.
RapidRisk: It is an advanced AI for risk-adjusted coding that calculates Hierarchical Condition Category (HCC) and Risk Adjustment Factor (RAF) scores while pinpointing opportunities for documentation improvement based on a comprehensive rule set developed in collaboration with prominent CDI leaders.
Manav Garg, Co-founder of Together Fund added: “We are thrilled about the transformative potential of AI in optimising administrative processes within the revenue cycle. We are confident that the RapidClaims team embodies the perfect blend of expertise, showcasing an in-depth understanding of the complexities within the U.S. healthcare system coupled with exceptional proficiency in artificial intelligence.”
Dushyant Mishra, Founder & CEO of RapidClaims commented: “We are just beginning to witness tangible benefits in terms of cost savings, speed, and revenue enhancement through AI utilisation. While automation is pivotal, we recognise the indispensable role of coders with their nuanced understanding of intricate rules and edge cases. This is the driving force behind our significant investment in the RapidAssist product, which has the transformative potential to elevate medical coding operations for coder-managing teams.”
