In today’s fast-paced healthcare landscape, accurately and efficiently handling medical billing and coding is more critical than ever before. The traditional methods of these processes, however, are exceedingly manual and leave room for errors, revenue loss, and compliance risks. Charta Health, a company dedicated to reinventing this workflow, has made significant strides towards solving these challenges by harnessing advanced AI technology. Recently, Charta secured $8.1 million in seed funding led by Bain Capital Ventures, alongside SV Angel, South Park Commons, SpringRock Ventures, Refract Ventures, and various strategic angel investors. This substantial investment aims to propel Charta’s efforts in optimizing research and development and scaling their team and AI-driven platform.
Addressing Inefficiencies in Pre-Bill Chart Reviews
The inefficiency of pre-bill chart reviews serves as a prevalent issue in the medical billing and coding domain. Specialists tasked with reviewing these charts often face overwhelming volumes that are impossible to manually scrutinize effectively, leading to a significant portion of charts going unchecked. This laborious process results in missed coding opportunities, lost revenue, unnecessary denials, and heightened compliance risks. Charta Health’s platform aims to alleviate these inefficiencies by using advanced AI algorithms that automate pre-bill reviews. Through automation, Charta is set to revolutionize how charts are reviewed, ensuring more thorough inspections while mitigating human error.
Automated Pre-Bill Review
One of Charta Health’s core functionalities involves the implementation of automated pre-bill reviews. The AI-driven analysis carefully scans each chart before submission, pinpointing missed coding opportunities that could significantly impact revenue. According to Charta Health, this feature has the potential to increase Relative Value Units (RVUs) per patient by up to 15.2%, which ultimately translates to an 11% revenue boost. Additionally, the platform promises a guaranteed return on investment (ROI), making it a highly appealing asset for healthcare organizations striving for efficiency and precision.
Noting the potential benefits, this automated system not only improves financial performance but also eradicates much of the manual labor involved in chart review processes. By systematically analyzing charts, AI can ensure that every coding opportunity is captured without the strain on human resources. The outcome is a more accurate and comprehensive review system that could transform the standard practices within the medical billing and coding spheres.
AI-Based Denial Prevention
Another pivotal aspect of Charta Health’s platform is its AI-based denial prevention mechanism. This feature works by validating claims in real-time, detecting coding errors and potential denials before they can cause revenue loss. Healthcare organizations often suffer from substantial financial setbacks due to claim denials, an issue that Charta Health aims to mitigate drastically. With the real-time claim validation, coding errors are flagged and corrected ahead of submission, reducing revenue loss by up to 70%.
This proactive approach to denial prevention is set to address one of the most financially draining aspects of medical billing. By incorporating real-time validation, Charta Health ensures that claims meet payer requirements, bolstering organizational efficiency and maintaining smoother financial health. The reduction in denied claims underscores the robustness of AI intervention, enabling a shift towards more reliable and sustainable revenue management in healthcare institutions.
Enhancing Compliance and Reducing Costs
In addition to preventing revenue loss and improving efficiency, Charta Health’s AI-driven platform significantly enhances compliance and aids in cost reduction. The automated system not only scrutinizes every pre-bill chart but also customizes compliance audits according to specific clinical guidelines, ensuring meticulous adherence.
Customizable Compliance Audits
The platform offers customizable compliance audits that scrutinize 100% of pre-bill charts against personalized billing and clinical guidelines. These AI-powered audits are conducted at a fraction of the traditional audit cost, specifically at 1% of the normal expense, thus mitigating compliance risks and preventing costly clawbacks. The auditable history stored within the AI software provides a clear trail for healthcare providers, bolstering the organization’s integrity and operational transparency.
As a result, healthcare facilities can operate with higher confidence, knowing that their billing practices align perfectly with regulatory standards. This steadfast approach to compliance is crucial in avoiding financial penalties and ensuring a streamlined review process. The reduction in audit costs brings another layer of efficiency, making compliance management not only more thorough but also financially sustainable.
Leadership Expertise and Industry Recognition
In today’s rapidly evolving healthcare landscape, the necessity for precise and efficient medical billing and coding has never been greater. Traditional methods of handling these processes are notably manual, leading to potential mistakes, revenue loss, and compliance risks. Charta Health, an innovative company committed to transforming this workflow, addresses these issues by leveraging advanced AI technology. Recently, Charta Health secured $8.1 million in seed funding. Bain Capital Ventures led the round, with contributions from SV Angel, South Park Commons, SpringRock Ventures, Refract Ventures, and various strategic angel investors. This significant influx of capital is intended to bolster Charta’s efforts in enhancing research and development, expanding their team, and advancing their AI-driven platform. By utilizing cutting-edge AI, Charta Health aims to streamline medical billing and coding processes, thereby reducing errors and boosting overall efficiency in the healthcare sector, ensuring compliance, and safeguarding profitability.
