🦄 Unicorner Startup of the Week:

IrisMed

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Automated Billing Management for Clinics

IrisMed automates billing workflows for outpatient clinics by handling payments from insurance providers. The platform minimizes revenue leakage and integrates fragmented data sources to resolve payment issues with insurers and prevent surprise patient bills. IrisMed claims to reduce an 8 hour process to 15 minutes for clinics, which saves them from an immensely labor intensive process. Its AI-driven approach aims to minimize errors and ensure clinics capture full reimbursements.

🔗 Check it out: irismed.co

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💰 Business Model

IrisMed charges a fixed fee based on factors such as average number of clients and collections from insurance providers. It tailors pricing based on the goals of the clinic.

📈 Traction and Fundraising

• Launched September 2024

• At 17 clinics currently, soon to expand to 26 clinics

• Part of TechStars S24 batch

👫 Founders

• Han Jing, CEO: Currently Venture Partner at NOEMIS ventures; Previously Head of Product @ wOS (YC W21), Growth Head of Platform @ Walmart Health, Data Lake Product @ Windfall (Acquired by Microblink), CS MS @ Cornell, MBA @ UChicago Booth School of Business, Econ BA @ Berkeley

🔮 Our Analysis

64% of physicians say they feel burdened by administrative requirements and 78% say staff shortages are a concern. IrisMed compresses an 8-hour manual process into 15 minutes, enabling clinics to resolve discrepancies faster. Another key advantage stems from IrisMed’s ability to integrate with fragmented data from a clinic’s CMS, emails, and Electronic Health Records (EHR) to reconcile payments. IrisMed is able to integrate with a clinic’s existing practice management systems, minimizing any friction to adopt its software.

IrisMed ensures its platform is affordable for smaller practices, as its fees scale with the clinic’s patient volume and collections. These clinics are able to capture a revenue upside, helping them grow faster and eliminating the need to hire specialized administrative staff. Once clinics adopt IrisMed’s solution, switching is costly and tedious, because IrisMed integrates deep into their workflows. 

Claim denials are over 73% currently, often because of erroneous or incomplete data. IrisMed’s investment in AI, which allows it to minimize errors, sets it apart from competitors. Founder and CEO Han Jing has 10 years of experience scaling optometry deployments, giving him deep insight into clinic pain points. At this rate, IrisMed is positioned to expand into clinics nationwide.

📚 Further reading

• Blog [IrisMed]

Written by Arjun Raj Loomba

🎙️ Founder Q&A 

This Q&A has been reconstructed from interview notes.

U: What challenges does IrisMed address?

Han: Today, it takes a lot of people to get your average clinic paid, whether it’s regular clinics, optometrists, or physiotherapists. There are also different data sources like CMS, emails, medical records etc., and it’s difficult to centralize data. The billing and collection workflow requires 8 hours of labor and data intensive work four times a month. Despite the long hours required, sometimes the process works incorrectly and the client receives an unexpected bill. This is a worrisome experience.

IrisMed works on automation and injecting AI in the back office billing workflow. We are faster than your average medical biller. IrisMed decreases error rates and compresses the workflow processing time to 15 minutes, so money can be collected faster and more often. IrisMed is currently deployed in 17 clinics across Texas and Arizona.

U: What does the billing and collection process look like? 

Han: The process works similar to the accounts receivable workflow. Paperwork is submitted upstream to an insurance company, followed by a waiting period. In the future, the clinic gets a receipt, and then must reconcile with its own records. In many situations, funds received from the insurance company don’t match with a clinic’s records. If reconciliation isn’t done, then a clinic may be losing out on their margins. This reconciliation process also results in a surprise bill sent to the client, who may be obligated to pay the difference. As a solution, IrisMed ensures that insurance companies pay correctly by filing appeals with the insurance companies.  

U: How do you implement AI to optimize the process?

Han: We use AI agents as an orchestrator for our workflows. What AI gives you as compared to last generation RPA tools is that they have a lot of fault tolerance built in. Previously, we had to build a lot of edge cases manually into our tools, but now AI is able to iterate autonomously on workflows.

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