What You Should Know
- AI-powered medical billing firm Procode Inc. announced a $10M Series A funding round led by Health Velocity Capital, bringing total venture funding to $14M.
- Funds two upcoming acquisitions of private practice billing agencies, mirroring its rollout following the acquisition of The Auctus Group (serving over 350 plastic surgery and dermatology providers).
- Combines Procode (automated CPT/ICD coding copilot), Procollect (billing team OS for AR acceleration), and the Auctus Provider App (real-time financial mobile portal).
- Published a comparative retrospective study in PRS Global Open demonstrating 86.7% overall CPT coding accuracy—outperforming human auditors (42.5%) and general LLMs (OpenAI, Gemini, Claude).
- Leveraging contingency-based billing models to scale from plastic surgery and dermatology into ambulatory surgical centers (ASCs) and all surgical subspecialties.
Specialty Roll-ups for Surgical RCM
The ambulatory surgery, medical billing, and surgical revenue cycle management (RCM) sectors face an acute operational bottleneck. While enterprise hospital systems have spent billions deploying automated billing technology, private practice surgeons and Ambulatory Surgical Centers (ASCs) remain heavily dependent on manual coding workflows and boutique, localized billing agencies.
Surgical coding is notoriously complex. Multi-coded operative reports—frequently requiring intricate Current Procedural Terminology (CPT) modifiers, National Correct Coding Initiative (NCCI) edits, and Medically Unlikely Edits (MUEs)—lead to high coding-related denial rates and long days in Accounts Receivable (A/R).
When private billing teams rely on manual coders or off-the-shelf, general-purpose LLMs, coding accuracy drops sharply on complex cases, leaving significant reimbursement dollars uncollected. To modernize surgical billing infrastructure and eliminate administrative margin drag, Procode acquires leading specialty RCM agencies and layering its fine-tuned, domain-specific AI platform directly over their existing operations to maximize provider yield.
Fine-Tuned Hybrid LLMs and Agency Integration
Procode’s platform unifies three core technologies into a single operational layer for surgical practices:
- Procode AI Engine: A fine-tuned hybrid LLM that ingests operative reports directly from the EHR, extracts CPT/ICD codes, cross-checks NCCI/LCD edits, and automates charge submission.
- Procollect OS: An internal operating platform for billing specialists featuring automated denial triage, root-cause reporting, and workflows designed to reduce days in A/R.
- Auctus Provider App: A mobile interface giving private practice surgeons real-time visibility into claim statuses, net collection ratios, and cash flow analytics.
- Empirical Validation (PRS Global Open): In a 120-case retrospective study comparing Procode against human auditors and general LLMs, Procode achieved 100% accuracy on easy cases and 80% accuracy on high-complexity cases (≥4 CPT codes), compared to 5%–12.5% for generic models.
“We’re on track to double The Auctus Group’s revenue and quintuple its EBITDA margin,” stated Jeff Cripe, CEO of Procode. “That matters because we bill on contingency — we only get paid when our clients get paid — so our growth is proof our AI is putting more dollars in providers’ pockets, not just automating paperwork.”
