The burden of health care costs is among the leading causes of financial distress across American households today.
We talked with Aman Magoon of Adonis about how this challenge is affecting both providers and patients, and what the Adonis platform is doing to simplify and strip unnecessary administrative costs out of today’s healthcare system.
Gain more insights from our conversation with Aman below.
The Process of Billing and Coding
“If you think about the healthcare industry, it's unlike any other where you as a consumer, as a patient, go into a doctor's office not knowing what services are going to be rendered, and that doctor, that provider, isn't always going to know how much they can expect to receive for the services they that they do ultimately perform. This is because of the fact that there's a third -party payer, there's an insurance company.”
“And what ends up happening is that the provider and the insurance company are essentially contracted with one another and have a relationship where they've agreed to certain rates for certain services, and what happens is this very long and human intensive process known as billing and coding. A lot of people refer to this as a revenue cycle and each touch point in this very horizontal process introduces opportunities for typographical errors, coding issues, mismanagement, and misrepresentation of a patient's demographic or insurance data.”
Identifying Problems Within The Process
“The challenge that the provider faces is number one, not knowing exactly when they'll be repaid for the services that they've rendered. Not knowing if they're going to be repaid for the total amount that they're due. Oftentimes, there are denials that result from either errors with the way the claim was submitted or errors with the way the claim was adjudicated, and this game of cat and mouse, as I refer to it, essentially elongates the amount of time it takes for a provider to get paid, and therefore also elongates the amount of time it takes for a patient to receive their medical bill. Which as you know creates a massive patient problem.”
How Adonis is Helping
“Adonis is able to hook in directly to the electronic medical record at any given provider, given the infrastructure that we've built, and disrupt the frontend of the revenue cycle by automating the way providers are collecting insurance and eligibility data and how they're collecting patient demographic information on the front end, prior to a patient's visit.”
“And then post visit, we're using machine learning and a ton of artificial intelligence to take those doctors notes and transcribe them into the appropriate codes and from there, as we go downstream into the back end of the revenue cycle, we're assembling these claims in a very deterministic fashion because we've ensured that the insurance data for the patient is valid and eligible. We can now hydrate this claim document with exactly the right information 100% of the time. We can ensure coding integrity because machines are performing this job instead of humans who you know ostensibly will make mistakes, and we can also submit those claims via clearinghouse. We can prioritize the way we're appealing claims when they're denied and so our platform today is 500% more efficient than the incumbent process where humans are essentially doing each one of those steps.”
Listen to the full discussion via the podcast player below or by clicking this link. If you'd like to connect with Aman, you can reach him via LinkedIn or learn more about Adonis on their website, tryadonis.com.