4 ms·

Good startup idea would be to work with medical practices to use AI to automate the disputing of the "downcoding" by insurers.

by coleca 1y ago

ActionHank 1y ago
The business will be very quickly bought up to kill the product.
- daveguy 1y ago
  If they can afford it. What's Mark Cuban been up to lately? Edit: in case the reference isn't clear -- https://en.wikipedia.org/wiki/Cost_Plus_Drugs https://en.wikipedia.org/wiki/Cost_Plus_Drugs And I think it is a sad state of affairs when the government has been so villified that we have to depend on billionaires for basic public good works.
  - ceejayoz 1y ago
    > the government has been so villified that we have to depend on billionaires https://knowyourmeme.com/memes/were-all-trying-to-find-the-guy-who-did-this https://knowyourmeme.com/memes/were-all-trying-to-find-the-g...
cogman10 1y ago
Man this is a hellscape. I can quickly see something like this turning in an AI arms race between insurance and the provider with each auto-approving/denying/disputing the other. All the while locking out smaller players because they can't afford the 3rd party disputotron.
- actionfromafar 1y ago
  In fact, you could take out an insurance which will help with the Disputotron costs, should they arise. No you can't know the costs in advance.
tantalor 1y ago
Hate it, thanks
Spivak 1y ago
You would have to leverage the law (if you have one) that involves the state resolving the dispute because otherwise the automated disputes would probably be dropped on the floor. The insurance company has the leverage because they're actually in possession of the money and the contract that gives them stupidly high discretion on how much to pay out. Doing nothing but flipping the burden, doctors get paid whatever they invoice and insurance have to claw it back would make a lot of this stonewalling bullshit go away. But with an openly corrupt government paid by insurance it'll never happen.
pragmatic 1y ago
Its a terrible business. The data is a disaster. Turnover is high, errs everywhere. Disputing is the easy part. Hard part is finding the contracts lol.
vjvjvjvjghv 1y ago
The result will be that doctor AIs will be fighting insurer AIs and the loser will be the patient. As always.
elwebmaster 1y ago
Already working on this, let's connect if you are interested: https://forms.gle/cxQZg5Q27PsT65d97 https://forms.gle/cxQZg5Q27PsT65d97
deleted 1y ago
[deleted]
abrichvi85 1y ago
I already have a solution to the downcoding practices of these health insurance carriers. I recently created an application called EMpowerAI that uses AI to analyze clinical notes and assign appropriate billing codes based on medical complexity or documented time. It also can enhance the Assessment/Plan to justify higher billing codes if the note content supports it. I presented it at the HRX conference in Atlanta on 9/4/2025 in the top 5 abstracts session. Here is the abstract: https://www.heartrhythmopen.com/article/S2666-5018(25)00291-0/fulltext https://www.heartrhythmopen.com/article/S2666-5018(25)00291-... As a Cardiac Electrophysiologist, I optimized the application for cardiology and EP, though it is scalable to other specialties. I am looking for beta testers and would appreciate any feedback. Here is a link to the app: http://em-billing-assistant.onrender.com/ http://em-billing-assistant.onrender.com/ Leave your name and email here if you would like to receive updates: https://forms.gle/MoVhdna81pq9F45NA https://forms.gle/MoVhdna81pq9F45NA

Good startup idea would be to work with medical practices to use AI to automate the disputing of the "downcoding" by insurers.

by coleca 1y ago

Good startup idea would be to work with medical practices to use AI to automate the disputing of the "downcoding" by insurers.

ActionHank 1y ago

The business will be very quickly bought up to kill the product.

daveguy 1y ago
If they can afford it. What's Mark Cuban been up to lately? Edit: in case the reference isn't clear -- https://en.wikipedia.org/wiki/Cost_Plus_Drugs https://en.wikipedia.org/wiki/Cost_Plus_Drugs And I think it is a sad state of affairs when the government has been so villified that we have to depend on billionaires for basic public good works.
- ceejayoz 1y ago
  > the government has been so villified that we have to depend on billionaires https://knowyourmeme.com/memes/were-all-trying-to-find-the-guy-who-did-this https://knowyourmeme.com/memes/were-all-trying-to-find-the-g...

cogman10 1y ago

Man this is a hellscape. I can quickly see something like this turning in an AI arms race between insurance and the provider with each auto-approving/denying/disputing the other. All the while locking out smaller players because they can't afford the 3rd party disputotron.

actionfromafar 1y ago
In fact, you could take out an insurance which will help with the Disputotron costs, should they arise. No you can't know the costs in advance.

tantalor 1y ago

Hate it, thanks

Spivak 1y ago

You would have to leverage the law (if you have one) that involves the state resolving the dispute because otherwise the automated disputes would probably be dropped on the floor. The insurance company has the leverage because they're actually in possession of the money and the contract that gives them stupidly high discretion on how much to pay out. Doing nothing but flipping the burden, doctors get paid whatever they invoice and insurance have to claw it back would make a lot of this stonewalling bullshit go away. But with an openly corrupt government paid by insurance it'll never happen.

pragmatic 1y ago

Its a terrible business. The data is a disaster. Turnover is high, errs everywhere. Disputing is the easy part. Hard part is finding the contracts lol.

vjvjvjvjghv 1y ago

The result will be that doctor AIs will be fighting insurer AIs and the loser will be the patient. As always.

elwebmaster 1y ago

Already working on this, let's connect if you are interested: https://forms.gle/cxQZg5Q27PsT65d97 https://forms.gle/cxQZg5Q27PsT65d97

deleted 1y ago

[deleted]

abrichvi85 1y ago

I already have a solution to the downcoding practices of these health insurance carriers. I recently created an application called EMpowerAI that uses AI to analyze clinical notes and assign appropriate billing codes based on medical complexity or documented time. It also can enhance the Assessment/Plan to justify higher billing codes if the note content supports it. I presented it at the HRX conference in Atlanta on 9/4/2025 in the top 5 abstracts session. Here is the abstract: https://www.heartrhythmopen.com/article/S2666-5018(25)00291-0/fulltext https://www.heartrhythmopen.com/article/S2666-5018(25)00291-... As a Cardiac Electrophysiologist, I optimized the application for cardiology and EP, though it is scalable to other specialties. I am looking for beta testers and would appreciate any feedback. Here is a link to the app: http://em-billing-assistant.onrender.com/ http://em-billing-assistant.onrender.com/ Leave your name and email here if you would like to receive updates: https://forms.gle/MoVhdna81pq9F45NA https://forms.gle/MoVhdna81pq9F45NA