While Brown University student Sophia Ghauri worked in a private practice ophthalmology clinic, she witnessed employees struggle with its billing system. She reached out to other providers and they all said the same thing: They needed an easy-to-use product that was proven to reduce billing costs and has a predictable pricing scheme.
Ghauri, who is pursuing a degree in design engineering for healthcare systems, is now the co-founder of Codified Health, a medical billing company powered by artificial intelligence. She’s developing the platform along with Hailey Chen, a Brown public health and business economics major; Cindy Zheng, a Brown applied mathematics and biology major; and Omar Imtiaz, a computer science major.
Ghauri said the company is “working to solve the nationwide multi-billion dollar problem of medical billing inefficiency.”
Q: How does Codified Health work?
Ghauri: Codified Health provides a medical code recommendation system, documentation verification tool, and interoperable software that engages with all existing EHR (Electronic Health Record System) platforms. We ensure claims are submitted promptly with faster payments, consistent compliance, and billing data transparency. It’s easy-to-use, and the system can produce the codes needed for reimbursement, confirm the patient’s chart contains the necessary documentation for any medical code and medical provider, and recommend additional medical codes (along with any other documentation) to include.
How is Codified Health beneficial for patients?
Our tool allows for more transparent billing. With our platform, we prevent over-billing and under-billing patients. This allows for patients to only be charged what is accurate for their visit.
How could a system like Codified Health relieve pressures from hospital systems and their employees?
Physician burnout — which can be worsened by the complexity of medical codes — results in high management costs and mistakes. Our business can help doctors save money by billing more effectively while also reducing the amount of time required to enter data.
Through our research, we have found that the bulk of billing errors are caused by avoidable mistakes and inefficiencies. These errors have resulted in an average Administrative Burden Index cost of $2.36 per claim for both insurers and physicians. But physicians lose thousands in reimbursement claims due to downcoding, and upcoding results in billions of dollars in excess government expenditures. Instead, we can ensure that patients are billed the exact amount they should be.
Cyber attacks on hospital systems are on the rise. How are you making sure that these records are protected?
We are hyper-aware of the sensitivity of medical data and are taking whatever measures we can to ensure it is not leaked or stolen. We are using secure, encrypted communications to transmit sanitized and anonymized data to minimize points of failure for data leaks.
How would you make billing data more transparent?
A private practice produces tons of data, much of which can be captured at the billing stage. We provide personalized data summaries for practices, so that providers find the information they want in an instant. By making the billing process accurate, easy, and faster, providers can have more time to focus on their patients. We also plan to expand the Codified Health system to auditing to prevent cases of overcharging in Medicare claims.
Have you worked with any clinics, doctor’s offices, or hospitals to implement Codified Health into their daily use yet?
We are partnered with clinics from a number of specialties, including pediatrics, gynecology, and ophthalmology. They have generously provided their de-identified EHR data to us to fine-tune our AI. We plan to begin our pilot run with beta testers by September of this year. Our goal is to make billing easier for private practices across the nation by the beginning of 2023.
Do you have any investors or have you done any fundraising so far?
Our startup has received $12,000 as a result of our acceptance into this summer’s cohort at Brown’s B-Lab (which is a flagship accelerator program for young entrepreneurs working on high-impact ventures). In the next eight weeks, we will begin networking with potential investors and venture capitalists with the goal of opening our first round of investments in August. (Those interested in investing can contact the founders.)
How is this platform different than what is already on the market?
Currently, the main competitors to us are human coders who take a portion of revenue to come up with the correct codes for the physician. By creating an autonomous process for coding, we can provide our service without taking a percentage of revenue.
How much does Codified Health cost to use?
Our pricing model will help physicians save in two ways. First, through the use of artificial intelligence, our services will help doctors save on the cost of labor needed to otherwise hire an employee to perform in-house billing or outsource to a third-party biller. Second, because our AI has been trained to verify the documentation required by insurance companies for each code, our billing services are more accurate than standard employees.
By minimizing billing mistakes, doctors can focus on their patients first and foremost rather than being distracted by either underbilling or Medicare/Medicaid penalties for incorrect billing. Additionally, we plan on charging a flat monthly rate per practitioner rather than charging per patient, resulting in predictable and non-variable costs.
The Boston Globe’s weekly Ocean State Innovators column features a Q&A with Rhode Island innovators who are starting new businesses and nonprofits, conducting groundbreaking research, and reshaping the state’s economy. Send tips and suggestions to reporter Alexa Gagosz at firstname.lastname@example.org.