Arintra raises $21 million to help providers win reimbursement struggle
Providers are increasingly losing ground in the fight for fair reimbursement – Payers are constantly refining their claims denial strategies, and recent legislation may add more obstacles.
On Tuesday, Arintra, a medical coding startup, raised $21 million in Series A funds to help solve the problem. The San Francisco-based company is expected to help health systems and physician groups reimburse accurately and effectively for every service they provide.
The startup’s funding round is led by XV Peak Partners and is involved from other funds such as peers Ventures, Endeavor Health Ventures, Spider Capital, Ten13 and Y Combinator.
Arintra was founded in 2020 by computer scientists Nitesh Shroff and Preeti Bhargava, respectively, who served as CEO and chief technology officer respectively. The company’s idea stems from Bhargava’s personal experience, a shocking large hospital bill – she was slapped by a $19,000 bill for four hours in the emergency room.
The bill's total eventually dropped sharply after months of back and forth communication with her health plan, but the experience was related to Arintra's co-founder. It makes them aware of the complexity of medical coding and makes them want to build a solution that makes it easier for hospitals to access code accurately and get paid in a timely manner.
Arintra's technology is like “a high-skilled coder operating on her peak performance 24/7”, Shroff said.
Coding is the key to earning reimbursement from commercial payers and government programs, but even the most accurate code is only as good as documentation.
Shroff points out that even if the encoding is accurate, document gaps can easily lead to lost revenue.
“Arintra goes deep into the documentation to find potential gaps, asking context-specific questions, such as, ‘Does the practitioner still execute Y and Z when he completes an X program?’ Based on our common knowledge of what practitioners usually do in such programs,” he explains.
Shroff said the platform combines it with an understanding of payee policies, coding guidelines and documentation requirements to provide viable, chart-specific feedback providers.
He added that it also has continuous document improvements, which helps ensure each chart has the highest level of coding.
“In addition, Arintra generates claims of payer opinions informed by contract rules and historical denial patterns. As a result, more claims are accurate for the first time – reducing denials, rework and document-related delays,” Shroff said.
He noted that the startup “provides everything inside the EHR” and makes money with a small fee per chart.
He also noted that most hospitals still process their coding manually, or that they outsource coding services completely. This is problematic because manual encoding does not scale, and outsourcing can help to be able to achieve capacity, but often introduces security risks, quality issues and turnover delays.
“Our biggest challenge is to change the status quo. Fortunately, the health system is already feeling the pain and knows they have to adopt technology, especially because insurance companies are using automation to reject claims,” Sluve said.
As insurers tend to automate to reject claims, Arintra bets automation may also be the key to making providers pay faster and fairly.
