Introduction
The healthcare system in U.S. spends almost $282 billion each year on billing and other costs. Doctors spend 3 to 4 hours a day on paperwork instead of treating patients. Do you know that about 9% of claims are denied and to correct each one it costs an average of $118? Worse, 4 out of 5 medical bills contain mistakes.
At Primrose. health, we’re fixing this broken system with AI in medical billing. We deliver results with 35% fewer denials, 42% faster payments, and 98% coding accuracy. We help medical practices save money by lowering billing mistakes and giving doctors more free time. This is how we’re doing it.
The Real Cost of Medical Billing Problems
Patients believe that if they don’t find and fix medical billing errors before payment, they will be more expensive.
The real cost of billing errors:
- Often claims are denied 10% of the time. For specific specialties, these may increase up to 23%.
- The cost to rework each denied claim is over the range of $117 – $125.
- Around 35-40% of revenue of the practices is lost to avoidable billing issues.
- Turnover of a few medical billing staff reached 30% in 2023.
- An average of 67% of patients report confusion about their medical bills. It leads to collection issues and payment delays.
- About 50-70% of denials are never reworked due to staff constraints, which may finally result in permanent revenue loss.
How AI Actually Solves Medical Billing Problems
1. Catching Denials Before They Happen
With advanced AI, Primrose.health reviews vast amounts of claim data to detect and prevent denials before submission.
- Our system predicts 96% of potential denials before they happen
- We fix 90% of these issues before submission
- Clients see first-pass acceptance rates improve from 70% to 97% on average
- Denial rates drop 32% within six months
- Hidden patterns in payer behavior become visible across thousands of claims
- We identify the specific 12-15 denial triggers most affecting your practice
Using Primrose.health’s predictive system, cardiology practices noticed that their denial rate dropped from 20% to 8% in just three months. This is just one example of how revenue cycle management is being transformed through artificial intelligence.
2. Getting Coding Right the First Time
Most claim denials happen because of coding mistakes. Our automated system spots the errors humans often overlook.
- Analysis of clinical notes finds missed codes in 22% of encounters
- System flags the top 7 coding errors specific to each specialty
- Accuracy improves up to 98% with AI assistance
- Upcoding risk drops by 63%, reducing audit exposure
- Average reimbursement increases from $14 – $22 per claim through proper code specificity
- 95% of quarterly coding updates are automatically incorporated
3. Making Billing Staff More Productive
AI in medical billing doesn’t just correct errors—it’s changing the way billing teams operate.
- Staff process 2.3x more claims per hour
- Simple claims get processed in minutes instead of hours
- Complex claims get flagged for human review with specific guidance
- Claim preparation time drops 60%
- Work prioritization improves cash flow by 17%
A 40% reduction in billing staff and a 12% jump in collections, one orthopedic practice shows how AI can dramatically boost revenue cycle performance.
4. Cracking the Payer Rule Book
Payers update their policies all the time. Our AI in medical billing tracks these changes across 253 payers:
- System identifies new claim rejection patterns within 3-5 days
- Practice-specific payer rules get updated daily
- 78% of payer policy changes are detected before they cause denials
- Payer-specific claim optimization increases first-pass rates by 19%
- Appeals success rates improve from 26% to 58%
- System generates payer-specific appeal language with 72% higher success rates
One neurology practice turned $43,000 in denials into recovered funds using our smart appeal strategies. This shows how automated coding and intelligent revenue cycle management can recapture otherwise lost revenue.
Humans and AI: A Powerful Partnership
Success in revenue cycle management is best achieved when technology and human expertise work hand in hand:
- AI handles the repetitive tasks: Around 76% of claims can be processed automatically with little to no manual effort.
- Technology uncovers hidden insights: Our platform has revealed 17 previously undetected reasons for claim denials across leading insurers.
- Experts step in when it matters: AI flags complex or unusual cases for human review, offering data-driven suggestions to support decision-making.
- Learning never stops: Each expert review helps refine and improve the AI’s future performance.
This human-AI collaboration creates smarter systems, faster processes, and more accurate results proving that combining both is more effective than relying on one alone.
Real Results for Medical Practices
AI is making a real difference in medical billing. And, our clients are seeing the proof firsthand.
- Revenue jumps 4-7%: Average practice adds $34,000 in revenue per provider annually
- Money arrives faster: Days in A/R drop from 35 to 19
- Administrative costs fall 33%: Staff spend 62% less time on claim rework
- Clean claim rates rise to 96%: Up from typical 70-75% industry average
- Staff satisfaction improves 40%: Teams spend time on meaningful work instead of repetitive tasks
Within a year of implementing our automated coding system, a 12-physician gastroenterology group recovered $385,000 in lost revenue—highlighting the transformative impact of AI-powered revenue cycle management.
What's Next: The Future of Medical Billing
Primrose.Health is redefining what AI can do in medical billing. Here’s how we’re leading the way:
- Natural language processing that pulls billing details directly from clinical notes
- Payment prediction models with 91% accuracy to help forecast cash flow more reliably
- Automated coding that captures 99% of missed charges, reducing revenue leakage
- Machine learning algorithms that detect underpayments based on contracted payer rates
- Seamless integration with 97% of electronic health record (EHR) systems
Up to $175 billion in potential savings across the healthcare industry through AI-powered revenue cycle management
The Bottom Line: Why Primrose.Health’s Approach Works
Medical billing is incredibly complex—too detailed for full automation, and too time-consuming for humans to manage alone. That’s why our hybrid model works. By combining the power of AI with the insight of experienced billing professionals, we’ve built a smarter, more efficient revenue cycle management system.
The impact?
More revenue for your practice.
Less time spent battling insurance denials.
More time where it belongs—with your patients.
Medical billing has been broken for decades. Now, with automated coding and AI, we’re finally fixing it. At Primrose.Health, we’re not just promising change—we’re delivering it.