Rewriting the Rules of RCM Collections

My journey into healthcare operations started with an Excel spreadsheet and a herniated disk.

Growing up, I always thought I was going to be a doctor, just like my grandparents. It turned out that I didn’t have the stomach for it, but when I was given the chance to join a healthcare services investing team, I was excited to contribute to an industry that I had always felt drawn to. I would be spared from the grisly aspects of delivering care, and instead work with CEOs, CFOs, and RCM leaders to grow their practices and serve more patients.

But it did not take me long to realize how behind healthcare was.

Early in my career, I found myself sitting down with a CFO who built a 30-tab Excel file to try to understand how much he could collect from each of his largest payors. It was March, and he still had no idea how much he could expect to collect from procedures completed in December. It only impacted 5% of his outstanding claims, but when your profit margin is 10%, that’s the difference between a stable business and an impending liquidity issue.

When providers can’t run their clinics and pay their staff, patients are left with fewer treatment options and delayed access to needed care.

I experienced that firsthand. While training for a marathon, I suddenly started having numbness down my left leg that only got worse. I spent days lying in pain.

I knew I needed to see a doctor, but every well-rated provider across multiple subspecialties was booked out for weeks. Desperate for anyone to help relieve the pain, I eventually saw a doctor who gave me three minutes of his time and diagnosed me with a pulled muscle. It took a well-trained PT, a re-herniation, another 9 months, and an MRI before the original herniation was confirmed.

Through these experiences, I saw two sides of the same coin. I knew from my career that providers’ financial challenges limited patients’ options for timely care. And as a patient, I lived this firsthand when what should’ve been a multi-month issue became a multi-year issue due to a lack of available providers.

The Industry

My personal experiences exemplify a broader trend in the industry. Denial rates are at an all-time high, with $262 billion in revenue to providers being denied each year. At the same time, labor and operational costs are rising, and 63% of RCM teams are understaffed. And with many hospitals’ operating margins already in the single digits, recovering every unpaid claim is essential to keeping the lights on.

This problem has existed for years and has only gotten worse since COVID. As more practices shut their doors, the gap between what patients need and what the industry can deliver will continue to grow. Our system is broken, and providers and patients pay the price.

Historically, it’s been incredibly hard to deliver a solution. Traditional software was programmatic, making it impossible to automate workflows for managing hundreds of payors, thousands of CPT codes, and millions of ways to work a denied or outstanding claim. Hospitals filled that capability gap with human labor, of which there is not enough, to perform mundane RCM tasks.

Large language models (LLMs) shifted this paradigm by powering AI agents that can follow specific rules and instructions to complete tasks in a workflow, but also learn when to deviate to accommodate different data formats and multiple steps. These AI agents can solve problems traditional software never could, and bridge workforce gaps that even the best recruiters could never fill.

Agentic AI allows us to rewrite the rules of what’s possible in RCM.

Amperos Health was founded to free RCM teams from manual work, fractured data, and financial hemorrhaging – and to bring abundance to healthcare RCM and finance. We’ve been agentic-first since day one, helping our clients across 3,000 clinical locations in all 50 states recover thousands of claims worth nearly $1 billion per year with our agentic workforce.

Today, we’re announcing an acceleration in our product and how we serve our customers.

What Today Means

We’re proud to announce two milestones for Amperos Health: we’ve launched the industry’s first agentic AI solution that works claims end-to-end, and we’ve closed our $16 million Series A funding round, led by Bessemer Venture Partners with continued participation from Uncork Capital and Neo.

The RCM industry has long been filled with programmatic point solutions, which fail when edge cases come up and can only serve a specific workflow pain point – for example, RPA-based browser automation to search payor websites, or AI calling to contact payors about denied claims. But to deliver real value – higher collections and lower cost to collect – providers need a solution that can work claims end-to-end within their specific practices, claims, and processes.

That’s what Amperos delivers. Our agentic solution can see what claims are outstanding, and work them end-to-end across multiple steps, including calling, portal automation, appeal letters, medical record requests, and more. RCM leaders can define exactly how agents work within their teams, following their workflows, SOPs, and prioritization preferences. At the same time, they gain unprecedented data visibility into denial root causes, payor activity, and outcomes – data that today is either near-impossible to aggregate, or worse, lives only in the heads of a team of dozens of people.

Our Series A moves us closer to delivering what providers and RCM leaders need to run thriving practices, but we recognize it’s just one step of many toward that future.

The Path Forward

The name Amperos comes from the word “ampere,” which is a way to measure electricity. When Alvin Wu, Wilson Wang, and I founded Amperos, our goal was to create a new solution that supercharges healthcare CFOs and RCM teams, and empowers provider organizations to grow their practices and serve more patients.

At the start, we saw providers and RCM teams overwhelmed with manual work, outdated systems, and an insufficient tool set. We worked 18-hour days monitoring and QAing AI performance, talking with customers, and shadowing users. Nothing felt better than seeing the direct impact we were having on our customers’ RCM performance: one VP of RCM filled gaps left by three empty RCM positions – which had been vacant for nearly a year – with our AI in just a few weeks. Another Chief Revenue Officer accelerated their team’s productivity by 3x, helping clear a denials backlog worth millions of dollars. In a Director of RCM’s words, the impacts they saw were “amazing.”

Since then, we’ve grown into a team of dozens across GTM, engineering, deployment, and operations, but our passion for rewriting the rules of RCM has remained our North Star.

This journey has been made possible with the support of our investors – Bessemer Venture Partners, Uncork, Neo, Nebular, and more – the hard work of our amazing team who believes deeply in our mission, and the vision of my co-founders, Alvin and Wilson.

Today’s milestone allows us to serve more providers and serve them in new ways. We’ll be expanding our ability to identify where, when, and why denials occur. From there, we will prevent them from happening before a claim is even submitted.

We’ve already helped our customers recover close to $1 billion in unpaid revenue. In the years to come, we have our sights set on capturing the rest of the $260+ billion providers need to keep doing what they do best: operating and growing their clinics to deliver the highest-quality care to their patients.

The journey continues.