RapidClaims uses AI to help US healthcare providers address $250b in denied claims

New York, US – February 16, 2024; Healthcare organizations are turning to automation with “revenue cycle management” to protect operating margins and the increasing claim denials from the payors. Every year, close to $265B in claims made by US healthcare organizations are denied because of the way claims are coded on payor documentation and delayed submissions are two chief reasons for the denials. Coding errors account for over 40% of claim denials, while untimely submissions contribute to 35% of denials; eligibility and prior authorization being some of the other aspects playing a significant role.

Addressing this pain point, RapidClaims has today emerged from stealth with a $3.1 million funding round to tackle the claims denial problem head-on with its medical coding automation module. The seed round was led by Together Fund, a $250 million global SaaS fund, with participation from Better Capital, Neon Fund, Peercheque, DeVC with angels and advisors coming from prominent US healthcare organizations including Oscar Benavidez (Executive Director, Mass General), Ankit Jain (Founder & CEO of Infinitus), and Sachin Jain (President & CEO of Scan Health) among others.

RapidClaims is led by Dushyant Mishra (CEO), Jot Sarup Sahni (CPTO), and Abhinay Vyas (CDO), each bringing a nuanced understanding of healthcare, data science, and scaling tech products. The idea for RapidClaims originated in 2018 during Dushyant 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.

RapidClaims recognizes the diverse challenges inherent in revenue cycle management. With a strategic focus on tackling medical coding initially, the company aims to simplify the rising complexity of coding processes and leverage the potential for AI to drive efficiencies over time. In recent years, coding complexity has surged significantly with diagnosis codes like ICD codes rising from 19,000 (ICD 9) to nearly 120,000 (ICD 11). Adherence to guidelines is becoming increasingly challenging due to rapid changes encompassing NCCI edits, NCD/LCD guidelines, Medicare policies, payor rule sets, among others.

RapidClaims has achieved success with six pilots within two months of its beta product launch in June 2023 and is poised to enhance product robustness even further with an additional five pilots already in the pipeline.

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 utilization. While automation is pivotal, we recognize 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.”

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 aimed at alleviating coding administrative overload:

RapidCode: Fully autonomous medical coding, streamlining the process with end-to-end automation.

RapidAssist: 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: Advanced AI for risk-adjusted coding that calculates HCC and RAF scores while pinpointing opportunities for documentation improvement based on a comprehensive rule set developed in collaboration with prominent CDI leaders.

More healthcare organizations are recognizing the need for revenue cycle automation to overcome workforce challenges, handle increasing claim volumes, mitigate revenue losses, and navigate the complexities of healthcare administration. This urgency is further fueled by the rise in claim denials from payors, which puts significant pressure on healthcare providers and exacerbates the already high administrative costs.

A recent study conducted by Bain & Company and KLAS reveals that 80% of U.S. healthcare providers are increasing their investment in IT and software, with a specific focus on prioritizing AI technologies. Revenue cycle transformation and automation are the top areas of focus for healthcare executives.

Manav Garg, Co-founder of Together Fund added: “We are thrilled about the transformative potential of AI in optimizing 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.”

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