Thought Leaders in Artificial Intelligence: Ram Swaminathan, CEO of BUDDI.AI (Part 3)

Ram Swaminathan: We go back in time with the hospital data sets; and we mine the claims data and the medical record data, the way the physicians writing the notes come from different backgrounds. We grab all of those variants in history and we customize the NLP technology for AI to understand these various documents.

We then understand the medical coding guidelines to the specific specialty and use case which the hospital is following, to get wide a dimension so that we might have a Medicare golden standard in America. However, every hospital in America is coding a little bit differently. That is a problem.

The subjectivity in medical coding is what we have perfected to bring in objectivity. You need evidence-driven coding and that is what we provide. The difference between Athenahealth’s approach to billing versus ours is the fact that we automate coding. We automate much of billing as well. 70% of our billing is automated. The 30% manual labor is identical to what Athena does, which is for accounts receivables.

If a claim gets denied, you have to call the insurance company and speak to them. We still need human personnel to call the insurance companies. We have shrunk the entire manual labor from 100% to 30%. Our goal is to keep innovating to get it to 20%. The other differentiation is the AI itself. We give contractual guarantees on the accuracy of the codes. We also do denial prediction and prevention.

We continuously learn because insurance companies don’t sit still. They keep changing their game. They change their rules in terms of how these claims can get denied. You have to constantly learn. For example, United changed their rule and are now reimbursing emergency charges. You have to be constantly in the loop for the machine to be smart enough to reduce the overall denials.

We are also in the same percentage of collections business model. The billing business model is the same, but the way we execute is different from Athena. We use a lot of AI for our innovation. Almost 70% of the process is automated. 

Sramana Mitra: Essentially, you are a next-generation Athenahealth.  

Ram Swaminathan: If you want to say that, then I will take it as a compliment. 

Sramana Mitra: When you go into deals, are you winning accounts from Athena?

Ram Swaminathan: Surprisingly, we are not even competing with Athena. It’s funny that you bring up Athena as a company. We collaborate with them. We think of Athena as a collaborator because they are a well-known EMR in the market. We love to collaborate with Athena and integrate our AI into Athena. Athena doesn’t go out and sell as an AI-based automation company, but we do. The part that we collaborate with them is where they get a revenue share from what we automate as well. It is a win-win situation. 

This segment is part 3 in the series : Thought Leaders in Artificial Intelligence: Ram Swaminathan, CEO of BUDDI.AI
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