A2Z Health

A2Z Health is solving improper healthcare payments stemming from insufficient & inaccurate clinical documentation. We target the underlying driver of over $100 billion in improper claims & denied payments annually.

The scale of this issue is staggering. According to the report "America's Largest Health Care Programs Are Full of Improper Payments" published by the Paragon Institute in December 2022, the estimated improper payment amount for Medicare Fee-For-Service (FFS) in 2022 was $31.46 billion, driven predominantly by lack of documentation. This represented 7.5% of total FFS payments. For Medicaid, the same study estimated improper payments hit $81 billion in 2022 spurred largely by missing or inadequate documentation.

Flawed clinical documentation lies at the heart of improper healthcare billing & denied claims according to experts. A legal guide on healthcare issues by Advocates for International Development (A4ID, 2019) explains how incomplete, inaccurate, or missing physician notes lead to coding errors that cause inaccurate claims & payment denials down the line. Medical coders rely on comprehensive clinical details to assign proper billing codes. Without robust notes, coders struggle to identify appropriate codes, resulting in mistakes, audits, & lost revenue.

Federal health agencies affirm this documentation-coding link. The Centers for Medicare & Medicaid Services report "Medicare Overpayments" (2022) cites "Incorrect coding" & "Insufficient documentation" as top reasons for claim overpayments. Meanwhile, the Paragon Institute's "America's Largest Health Care Programs Are Full of Improper Payments" (2022) flags "Documentation problems" as the primary driver of improper Medicare payments.

The verdict is clear: Flawed physician documentation enables coding mistakes & improper billing. Complete, accurate notes are essential for proper claims submission & revenue integrity.

For providers, denied claims due to inaccurate codes require tedious appeals fighting for rightful reimbursement for services already rendered. Payment recoupment audits translate to hours of administrative work contesting denials & supplying additional records. Worse still, providers bear the cost burden if appeals uphold improper payment decisions, forced to absorb expenses for care delivered with no compensation.

For patients, improper payments & denied claims lead to higher premiums & out-of-pocket costs as insurers pass on the billions lost to mistaken payouts. Excessive documentation burdens on physicians detract from patient care. Patients suffer from less attentive care.

System-wide inefficiencies are immense, with few appeals despite billions in potential erroneous unpaid services. Lengthy audits also waste countless provider hours, since most denials are overturned.

Key problems highlighted in research by Herd & Moynihan (2021) in Health Services Research include: physicians spend 49% of their time on desk work compared to only 27% on clinical face time with patients; physicians spend 2 hours on paperwork for every 1 hour in direct patient care; 75% of Medicare Advantage claim denials are overturned, but only 1% of beneficiaries appeal.

In summary, documentation issues create immense burdens. By optimizing clinical notes upfront with AI, we prevent billing errors & enhance care delivery. Our solution proactively addresses improper billing & coding mistakes before claims submission, preventing burdensome audits & clawback and reducing waste for providers, payers, & patients.

A2Z Health offers a real-time clinical documentation auditing solution powered by AI deeply embedded in clinical workflows. Our software integrates with electronic health records using the highest security protocols, including encryption, to analyze clinical encounter notes as they are written. Using natural language processing, conversational AI and rules-based logic, our algorithms are able to provide feedback on gaps or issues, along with suggestions and templates to improve documentation, aligning the notes with regulatory and payer guidelines.

Our solution seamlessly fits into clinical workflows to drive impact and equip clinical teams to optimize encounter notes in real time, before finalizing, enhancing completeness and accuracy to support proper billing codes and regulatory requirements. Our algorithms continuously learn from new data to improve optimization recommendations over time. By proactively auditing and enhancing documentation at the point of care, we boost documentation quality to prevent improper claims and ensure appropriate and timely reimbursement without the anxiety of insurance audits.

Our algorithmic solution directly targets this root cause by:

• Auditing physician notes in real-time as they are written in the EHR

• Analyzing the documentation and providing feedback on gaps or errors

• Suggesting specific improvements so notes contain the required elements to justify billing codes and meet regulatory and payer documentation requirements

• Enhancing documentation before submission to prevent improper claims

• Providing feedback specific to the insurance provider’s guidelines and adjusting metrics based on historical payer engagement notes

Our AI clinical documentation solution is purpose-built to serve the entire healthcare system, with positive impacts felt by providers, hospitals/clinics, organizations, insurers, and most importantly, patients receiving necessary care. In essence, we free providers from documentation burdens so they can devote focus to delivering quality care.

Some key highlights of how our platform empowers the system:

• Preventing claim denials and audits that jeopardize revenues and operations. Our solution boosts documentation accuracy to minimize these financial risks.

• Reducing administrative overhead and inefficiency by avoiding appeals and rework caused by improper billing. Our automation saves countless hours.

• Enhancing documentation quality so providers can demonstrate coding compliance and medical necessity to payers.

• Integrating directly into existing EHR workflows to make optimized documentation seamless for providers. No disruption.

• Giving peace of mind that records capture the full patient story and services delivered to support appropriate reimbursement.

• Ensuring the highest quality of care is provided to patients by guiding providers through thorough, best practice-based encounters.

• Reducing frictional costs from payers that are reserved for unnecessary and intrusive audits.

• Allowing care providers to focus more on delivering excellent care rather than battling reimbursement.

By optimizing clinical documentation with AI, we promote accurate billing and coding so providers get properly reimbursed for services provided. This brings financial stability and operational efficiency that concentrates efforts on enhancing patient outcomes.

In turn, reducing system waste and overhead has the potential to lower costs for consumers and make care more affordable through reduced insurance premiums or out-of-pocket expenses.

Our team is well-positioned to deliver this AI clinical documentation assistant solution based on our founder's and advisors' combined expertise in healthcare, AI, and billing compliance.

My American dream began when I (Biruh) immigrated to the U.S. in my youth with my family seeking opportunity. While attending Bridgewater University for my undergraduate studies in Business Administration, my life unexpectedly pivoted due to personal tragedy.

I was devastated witnessing a loved one's battle with severe mental illness that ultimately took their life, despite our efforts to find treatment. This trauma sparked an unshakeable purpose within me - that I would dedicate my efforts to honoring them by transforming care for those suffering silently.

Months later, driven by anguish from their untreated illness, I joined a nonprofit expanding mental health services. For years I worked closely with underserved communities before becoming an early member of a startup disrupting mental healthcare delivery.

We rapidly scaled from 1 site in Arlington, MA to 14 locations across 3 states in just 6 years. In the process of expanding our services to reach more people in need, I saw lingering systemic challenges that made providing efficient health care difficult. One such recurring example would be providers would waste a lot of valuable time being lost in mountains of paperwork rather than caring for patients.

Having experienced painful audits myself, I realized technology could eliminate this waste. My vision became developing an AI assistant to optimize documentation and free clinicians to transform lives, inspired by my family's struggles.

I have over 15 years of expertise in healthcare revenue cycle management and complex payer audits as an executive. In my prior role as VP of Operations, I managed billing teams, led organizational audit responses, and appealed unfair denials, recouping hard-earned revenue.

I have firsthand experience of how small documentation issues trigger huge revenue losses for health systems. I have directly faced the pain of onerous documentation demands and worked closely with clinical teams to improve note quality to meet stringent payer guidelines.

This deep real-world expertise allows our team to intimately understand documentation challenges and design an optimized AI solution. Combined with our technical capabilities, we are positioned to transform clinical documentation integrity across the revenue cycle. Specifically, our co-founder brings extensive knowledge in conversational AI and NLP from building financial services chatbot assistants. Leveraging advances in NLP to develop empathy-driven documentation assistants is his passion. Our advisor also has successfully built and implemented NLP models that combine human and artificial intelligence to enhance productivity.

We also have a strategic finance expert, Phlectus, on our team. With an MBA and commerce background, Phlectus increases efficiency through data analysis, budget optimization, and process improvements. Her robust business acumen and unwavering commitment equip her to drive innovation.

Together, our hands-on healthcare experience and technical AI acumen equip us to develop an innovative documentation solution that reduces administrative burden and augments physicians' capabilities. We are eager to unite our hard-won industry insight with leading AI capabilities to deliver meaningful change.

Here are some key factors that make our AI-powered healthcare auditing solution innovative:

• Real-time clinical documentation analysis: Our software provides instant provider feedback within the EHR during the encounter workflow, unlike post-payment reviews. This allows addressing any shortcomings in encounters proactively.

• Integration with EHRs: We seamlessly integrate with existing EHR systems via APIs (application programming interface) rather than requiring standalone portals. This makes adoption frictionless.

• Continuous learning: Our models continuously retrain on new real-world data from customers to improve accuracy, unlike static rules-based approaches.

• Workflow optimization: Our design optimizes clinical workflows rather than creating extra work. This achieves user buy-in.

• Explainable AI: Our AI system shows users the reasons and logic behind its suggestions for improving documentation. This transparency helps users understand and trust the AI guidance. Many AI systems are "black boxes" that do not explain their recommendations, which can cause distrust.

• Our AI auditing system not only flags documentation issues, but also provides the rationale for why it identified those issues and made those specific suggestions. Showing the reasoning behind the AI's feedback promotes trust and adoption by providers since they can follow the model's logic.

• Risk scoring: Our software provides risk scoring to focus audits on high-risk documentation with the greatest impact on revenue and compliance.

• Customizable: Our AI models can be customized to address organization-specific documentation requirements, like flagging missing diagnosis code prefixes defined by a provider network or gaps in documentation for payer programs they participate in, unlike inflexible one-size-fits-all vendor solutions.

• Proactive protection: We prevent improper billing before it happens rather than chase repayments of improper payments and overpayments after the fact, improving financial performance.

In summary, our innovation is providing real-time, workflow-integrated, continuously learning, AI assistance to proactively improve clinical documentation integrity to help generate revenue, improve complaince, and decrease audits.

At its core, our clinical documentation solution furthers UN SDG 3's aim of enabling good health and well-being for all people by significantly improving healthcare infrastructure efficiency and cost-effectiveness.

We strengthen health systems by:

• Enhancing documentation accuracy to meaningfully improve quality of care through better diagnosis, treatment, and care coordination.

• Proactively correcting documentation to avoid expensive appeals and rework that drive up system costs.

• Helping providers demonstrate true medical need to support universal coverage goals.

• Enabling providers serving vulnerable groups to get properly reimbursed for care provided.

• Leveraging AI innovation to drastically enhance clinical documentation and care delivery integrity.

• Increasing access to affordable healthcare by preventing improper claim denials that jeopardize provider revenue and operations.

• Supporting vulnerable populations by enabling providers serving marginalized groups to get properly reimbursed.

More accurate documentation means more appropriate treatment. By optimizing this critical backbone of care with machine learning, our solution makes healthcare radically more efficient. This allows redirecting resources to improve delivery and outcomes for all people, powerfully furthering SDG 3's vital purpose. We welcome partners to amplify our contribution.

Our clinical documentation auditing solution applies a suite of advanced AI techniques:

• Natural Language Processing: Extracts key clinical concepts from unstructured physician notes, understanding semantics and context.

• Neural Networks: Deep learning models identify gaps in documentation and coding risks.

• Explainable AI: Surfaces the rationale behind each optimization recommendation to build provider trust.

• Reinforcement Learning: Optimizes suggestions to maximize documentation enhancements.

This AI stack is powered by:

• Electronic Health Records: Real-time data integration provides access to up-to-date structured data and physician notes.

• Longitudinal Patient Records: Historical records allow for identifying irregular documentation patterns over time.

• Expert Annotations: Thousands of notes are annotated by clinical experts to teach model documentation best practices.

• Proprietary Coding Algorithms: Custom rules and guidelines engineered by our team encode billing requirements.

• ICD-10-CM
  

Our unique advantage is continuous access to the latest clinician-authored notes across care settings to retrain models. Superior, privacy-protected data powers our accurate and intelligent auditing capabilities.

We take ethical and responsible AI very seriously. Some ways we mitigate risks:

• Data Privacy: We follow universal principles like data minimization and implement the highest standards like end-to-end encryption. Health records are accessed only via HIPAA-compliant APIs and Business Associate Agreements. We exceed sector norms by immediately anonymizing and aggregating all data, aligning with global best practices.

• Explainability: Our models provide explanations for audit suggestions so users understand the logic.

• Validation: Clinical experts continuously review model audit outputs to check accuracy and relevance.

• Compliance: External legal/compliance reviews ensure the model aligns with billing regulations.

• Security: We use best practices like having our programmers review each other's code, hiring hackers to test breaking into our systems, and getting independent audits to check we meet security standards. This is like doing regular virus scans and inspections on your car to ensure safety.

• Monitoring: Round-the-clock monitoring, algorithm audits, and retraining on new data to ensure models remain effective and unbiased post-deployment.

• Risk Reviews: We conduct AI risk assessments evaluating data bias, security threats, privacy harms, and other risks on an ongoing basis.

By prioritizing transparency, rigorous pre-deployment testing, monitoring, third-party audits, expert oversight, and collaboration with human experts, we work to ensure our AI auditing enhances clinical documentation integrity in an ethical manner. We welcome additional guidance on responsible AI practices in healthcare.

Over Next 12 Months:

To achieve our conceptual stage goals, we plan to:

• Work closely with a small set of pilot partners to gather clinical user feedback and optimize our auditing model and product experience.

• Leverage real-world data from pilots to continuously improve accuracy of our AI documentation recommendations.

• Prioritize building integrations with clients across multiple EHR platforms to demonstrate seamless adoption potential.

• Gather integration data and analysis from pilots to validate model impact on documentation quality and opportunities.

• Collaborate with compliance experts to refine auditing rules aligned with billing requirements.

• Publish compelling patient stories and testimonials showcasing how optimizing documentation through our solution meaningfully improved their care experiences and health outcomes.

• Develop our B2B business model and pricing plans

Next 5 Years:

To accomplish our future scale goals, we plan to:

• Publish additional studies with expanded pilots to showcase model effectiveness across provider types.

• Develop partnerships with payers, regulators and accreditation bodies to  improve collaboration between all parties in the care delivery spectrum.

• Continue to brand and raise awareness on the impact of our platform towards showcasing the improvements that could be made in the care delivery and insurance coverage spaces.

• Build integrations with numerous EHR systems and clinical workflows to maximize reach.

• Grow our engineering, product, compliance teams to match our expanding customer base.

• Continuously improve our AI models by training on new data and integrating state-of-the-art techniques.

• Expand functionality to address adjacent use cases like automated coding based on optimized documentation.

The focus is on driving widespread adoption to maximize the impact on improving documentation, coding, reimbursement accuracy and reducing healthcare costs due to improper payments.

2 Co-Founders 

2 Contractors

3 Advisors 

<1 Year

At our core, we believe diversity powers innovation and equitable access drives impact. That's why inclusion and representation are fundamental to our culture.

• Our minority-led founding team sets the tone for embracing diverse perspectives at every level. We will build on this foundation.

• Through ongoing training, inclusive policies, and open dialog, we are creating a workplace where everyone thrives and brings their authentic selves.

• We foster professional growth by supporting traditionally underrepresented groups in reaching leadership roles.

• We are forging partnerships with advocacy groups and community leaders to co-create solutions tailored to disadvantaged populations.

• Regular assessment of diversity metrics keeps us accountable to our equitable ideals. Progress must be measured.

At the heart of our culture is the belief that healthcare should include everyone on equal terms. We welcome partners who share our commitment to equity in access and outcomes.

Our SaaS solution performs real-time AI auditing of clinical notes, providing feedback within the EHR to optimize documentation integrity. We are founded by healthcare and AI experts who architected payer audit systems. Compliance is central to our operations.

We deploy our HIPAA-compliant cloud product via tight EHR integrations, targeting large health systems as customers. Our value proposition focuses on enhanced revenue and reduced administrative costs.

Our pricing includes:

• $25 per provider monthly fee

• 2% of generated revenue capped at $200/provider monthly

This pricing model provides steady subscription revenue while aligning incentives.

We leverage partnerships for non-core activities to maintain lean operations. Prioritizing product roadmap features happens collaboratively with clients. Revenue sustains our engineering, clinical, and customer success teams.

We ensure rigorous privacy, security protections, and validation testing to meet healthcare regulatory requirements. Our model allows us to scale impact for customers while running an efficient, compliant organization.

Our path to sustainability centers on scalable impact. We aim to drive broad adoption that improves clinical documentation integrity across healthcare.

Revenue Engines

• Our SaaS subscription model builds recurring revenue while aligning value through usage-based pricing.

• We will expand efficient go-to-market channels through health system partnerships and enterprise licenses.

• Adding high-value features for power users and analytics creates upsell opportunities.

• Integrations to existing EHR software

Disciplined Growth

• Our cloud infrastructure enables measured growth without heavy overhead.

• We will maintain lean operations through automation, focused hiring, and selective outsourcing.

• Reinvesting revenue into targeted sales, marketing and R&D will compound growth.

Measured Funding

• We are seeking pre-seed capital to optimize initial product-market fit and momentum.

• Profitability is a priority to minimize dilution and dependence on future financing.

• If growth warrants, we will make disciplined use of venture funding to expand our impact significantly.

Our commitment remains to sustainable models that balance purpose and profit. We welcome any advice on fine-tuning our plan to deliver scalable social impact through long-term financial vigor.

Current (2023)

• Operating costs: $15,000/month (cloud services, software, marketing)

• Team:

  • 2 co-founders

  • 2 AI and software engineers: $2,500/month each

  • Estimated human capital cost: $5,000+/month

Next Year (2024) Projection

• Operating costs: $25,000/month

• Team:

  • 2 co-founders

  • 4 AI and software engineers at $2,500/month each

  • 1 business development lead at $3,000/month with equity potential

  • Estimated human capital cost: $13,000/month

• Total estimated 2024 operating costs: $456,000.

Funding Request

Based on these estimates, we believe $90,000 in funding would provide a crucial runway for the next 10-12 months without being dilutive as we focus on product market fit.

This would allow us to:

• Accelerate core engineering work

• Build integrations with 1-2 EHR platforms

• Hire our first business development lead

• Begin initial provider deployments

The funding would get our initial go-to-market activities off the ground and accelerate our product to market fit while we work toward a seed round for larger scale growth. We aim to be judicious and are open to guidance on the ideal amount to fulfill our 2024 plan.

The Cure Residency represents an unparalleled opportunity to accelerate our mission of transforming clinical documentation and care quality through AI auditing. As a young startup, we would gain invaluable support in several key areas:

Seed funding would provide crucial capital to optimize and rapidly advance our solution next year without dilutive financing. This runway would enable us to focus on enhancing our product and expanding our reach, rather than fundraising.

Mentorship from experienced healthcare founders, leaders and investors would offer indispensable guidance as we refine our strategy. Their insights on product-market fit, go-to-market positioning, scaling impact responsibly and other topics would provide a tremendous learning advantage.

Educational programming gives us exposure to cutting-edge best practices in healthcare entrepreneurship, data science, ethics and related topics to inform our approach. We look forward to learning from top experts.

Networking opens doors to partners, pilots, advisors and collaborators across healthcare, technology and policy that can profoundly amplify our success. These connections are equally as valuable as funding.

In addition to critical capital, the residency’s unparalleled knowledge-sharing, community and connections offer advantages that would supercharge our growth. We would be honored to learn from and build alongside the esteemed mentors, partners and peers this prestigious program provides. The Cure Residency can springboard our mission of enhancing clinical documentation and care quality immensely. We are deeply grateful for the consideration.