Health Systems Invest in Revenue Cycle Management Vendor CodaMetrix

Feb. 28, 2023
AI-based platform was developed at Mass General Brigham to alleviate medical billing challenges

Revenue cycle management platform vendor CodaMetrix has closed a $55 million Series A funding round that includes several health system investment arms.

Currently in partnership with 10 health systems and academic medical centers, including Mass General Brigham, University of Colorado Medicine, Yale Medicine, and Henry Ford Health Systems, CodaMetrix says it works to improve clinical coding accuracy and reduce revenue leakage.

The software-as-a-service platform uses machine learning, deep learning, and natural language processing to continuously learn from, and act upon, the clinical evidence stored in electronic health records (EHRs). As a multi-specialty platform that classifies codes across radiology, pathology, surgery, gastroenterology, and inpatient professional coding, Boston-based CodaMetrix said it is the first platform to have an impact across departments by alleviating administrative burdens from billing staff.

The technology behind the company was developed at Mass General Brigham. “As a company born out of one of the largest and most innovative health systems in the country, our team experienced firsthand the pain points caused by medical billing challenges, including delayed payments, claim denials, coder shortages, high costs, and the time they take time away from patient care,” said Hamid Tabatabaie, CodaMetrix president and CEO, in a statement. “To address these challenges, medical coding, as the proxy for evidence of care provided, has to become largely autonomous. Beyond the clear cost and efficiency advantages, automation for the first time will make it affordable and practical to ensure selected codes include the clinical specificity required for use cases in population health, value-based care, care management, research, and quality initiatives. Our goal is to use our platform to bridge the gap between clinical and administrative use cases of medical coding, while continuously delivering actionable insights to make the revenue cycle faster, smarter, and less of a burden on physicians and the coding workforce.”

“Frustrated by the lack of quality autonomous solutions out there, we built CodaMetrix through the lens of healthcare revenue cycle experts, addressing real health system and physician concerns. Our outcomes — a 70 percent reduction in manual labor — 59 percent reduction in denials due to coding, and a significant increase in cost savings — is the proof,” said Michael Mercurio, vice president of Physician Revenue Cycle Services at Mass General Brigham.

The funding round was led by SignalFire. Frist Cressey Ventures (FCV), Martin Ventures, Yale Medicine, University of Colorado Healthcare Innovation Fund, and Mass General Brigham physician organizations also participated in the round.

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