Accurate and compliant medical billing and coding is crucial in ensuring patients receive accurate reimbursement for healthcare services and for the financial stability of healthcare organizations. However, inaccurate coding from the current antiquated systems can cause reimbursement errors, claim denials and regulatory violations.
According to a 2022 Health Affairs Journal study, an average of $215 of an inpatient’s surgical bill in the U.S. goes toward medical billing and insurance-related processing costs, the highest amount it found worldwide. The lowest amount was $6 in Canada.
Why is there such a high percentage of payment going just to the mechanical processing of a bill? Reducing healthcare costs in the U.S. is a big problem that needs many solutions, but this specific issue seems like it should be solvable.
Well, Durham-based startup Keebler Health thinks it has the answer. That’s why GrepBeat sister company Primordial jumped in with an investment that it announced today.
There are no magical cookie elves behind Keebler Health, but Co-Founders Isaac Park (CEO) and Andrew Stickney (COO), plus CTO Kevin Hill, have created something seemingly as magical in streamlining the process of medical billing.
While co-investing in a medical company before Keebler, Park and Stickney started to see a whopping 5-7 percent of medical procedure costs going to billing and coding of the charges alone, a sector that’s separate from the medical providers and insurance companies. That glaring problem struck them as an opportunity.
That’s why they created Keebler Health, a coding “co-pilot” that helps medical coders, billers and auditors ensure accuracy, reduce denial rates and increase compliance levels. Keebler’s solution utilizes a proprietary artificial intelligence (AI) model that highlights hidden complexities from notes automatically and easily for medical staff to review.
“There’s nothing holistically fraudulent about this system,” Park said. “But it does sort of present what we’re saying are ‘symptoms’ of a poor hand-off between clinical documentation and medical coding and billing teams.”
From personal experience
Park faced a similar “catalyzing” moment personally when it came to making a decision for a healthcare procedure. He asked his healthcare provider how much it would cost, and they didn’t know. He asked a payment provider and they didn’t know. He thought that if no one really knew how much a procedure would cost, how can he make a clinical decision at point of care that had a significant impact on his health?
“The lack of transparency and predictability around what financial outlay it’s going to be for is just wild to me,” he exclaimed. “You can’t run a business on that, let alone healthcare on that. So if we can move the needle a little bit on helping define that predictability or visibility, I think we’re making the world a bit of a better place.”
Described as a “Grammarly for medical coding,” Keebler’s B2B SaaS product will detect inconsistencies and omissions quickly and more efficiently for coders to send over to provider teams for clarity, flattening variation on reimbursement levels. With this technology, they hope to expand and help the medical coder market into a more reliable asset to healthcare.
“The coding market has a tremendous labor shortage right now and it’s only anticipated to get worse,” Park said. “We want to ensure that we can increase or amplify their ability to do this work at speed and at scale and with a high degree of accuracy.”
Inaccurate and otherwise “bad” coding can affect every person involved: the providers, insurers, auditors, insurance companies and, most importantly, the patients. With Keebler’s AI-assisted model, not only will the coding become more easier and precise, but it will also create more accessibility and opportunities for the medical coder job market to expand. It will ensure that the product, coder and provider are supporting each other in delivering optimal codes and claims in record time.
“Almost every AI system will inevitably shift, die and fail,” Stickney said. “It’s the ones that have humans in the loop that won’t fail catastrophically. We want to make sure there’s always a human in the loop and to approach the deployment of artificial intelligence into the human medical coding space with thoughtfulness.”
Keebler Health is currently in its alpha stage. In addition to Primordial, its investors include Chicago-based New Stack Ventures and the Triangle Tweener Fund.
