Why PELTO Health Partners Is Exploring AI-Powered Coding: Tackling Healthcare's Labor Crisis with Innovation
- Aubrey Ibele
- Aug 15
- 5 min read
Updated: Aug 19
Administrative Burnout Is No Longer Looming—It's Here
Managing revenue cycle performance has never been more complex. Margins are tightening, reimbursements are decreasing, payer scrutiny is increasing, documentation requirements are escalating, and patient volumes are growing. The traditional approach of hiring additional FTEs to manage the burden isn't sustainable. PELTO Health Partners saw the writing on the wall. Founded in 2022, PELTO serves a collective of 8 independent practices of over 600 physicians spanning coast to coast. As a physician-owned and led organization, their mission centers on preserving the independence and financial viability of specialty practices in an increasingly consolidated healthcare landscape. PELTO has consistently demonstrated that independent practices can thrive through strategic innovation and collective expertise. This leadership mindset became evident when facing revenue cycle pressures: rather than accept the reality of these challenges, they chose to lead. Their guiding question: What if technology could augment our people instead of replacing them? "
“Most of the groups are just trying to keep the lights on. Staffing is a huge issue, particularly in medical coding, and they need help.” — Kyle Swarts, aiHealth
Solving the medical coding crisis quickly emerged as the logical target for innovation. Medical coders are increasingly hard to find and retain. Coding is becoming more complex, and current revenue cycle management workflows struggle to keep pace with existing coding volume, let alone accommodate growth.
A task this critical—and this strained—was ripe for transformation.
The urgency couldn’t be clearer.
Shrinking Margins
Independent practices operate with margins averaging less than 3%1
Medicare reimbursement has dropped over 20% since 20012
1 in 5 practices is now considering acquisition or closure1
Workforce Shortages
There’s currently a 30% shortage of certified medical coders3
The field is growing, but not enough graduates are entering the workforce
The average age of coders is 45, meaning experienced coders are nearing retirement, taking historical knowledge and coding expertise with them4
Operational Complexity
Denial rates have surged to 33%, up from 20% in 20165
The average cost to rework a denied claim is $1186
Nearly one-third of denials are fully preventable, and 43% of those are unrecoverable6
Why PELTO Was Positioned to Lead This Innovation
PELTO's approach to the coding challenge wasn't reactive—it was strategic. Since its founding, the organization has focused on delivering group purchasing power, providing access to benefits solutions, and advisory services that allow member practices to remain competitive in the independent healthcare space. PELTO successfully guides member practices through major industry shifts, including value-based care transitions and evolving regulatory requirements, making it well-positioned to tackle the coding challenge strategically.
"Our physician leaders live these challenges daily, which gives us unique insight into what actually works in practice versus what sounds good in theory," explains Rachel Uzlik, CEO of PELTO.
This hands-on understanding positioned PELTO to recognize that the coding shortage wasn't just a staffing problem—it was a systemic workflow challenge requiring technological augmentation. The organization's collaborative approach to problem-solving, combined with its commitment to maintaining practice independence, made it an ideal testing ground for innovative revenue cycle solutions.
Why PELTO Was Positioned to Lead This Innovation
To scale revenue without increasing operational costs, PELTO turned to autonomous coding: artificial intelligence (AI) powered automation designed to auto-code encounters with minimal human intervention and high accuracy at scale. In aiHealth, PELTO sought a partner that could not only meet their technology requirements but also share their commitment to sustainable independence for physician-led practices.
PELTO’s partnership with aiHealth was never just about adopting new technology—it was about philosophy. PELTO believes in the power of independent medicine and works to deliver financial and operational benefits at scale, enabling its practices to maintain revenue, equity, and control. aiHealth emerged as the right partner because its vision aligned perfectly: augment human teams instead of replacing them, relieve administrative pressure, and enable practices to focus on patient care rather than paperwork.
Why aiHealth Stood Out
Operationally Proven for Complex Practices: aiHealth’s platform demonstrated successful deployment in challenging practice environments. It integrated effectively with EMRs like Phoenix Ortho, NextGen, athena, eCW, and Veradigm—a crucial requirement for PELTO member groups such as Proliance Surgeons—and came with a track record of working directly with practice IT teams to handle unique PM/EMR challenges.
Flexible Deployment Approach: Rather than imposing a rigid go-live plan, aiHealth embraced phased rollouts that started with human-in-the-loop auditing, ensuring coders trusted the AI’s output before moving to automation.
Specialty-Specific Intelligence: aiHealth’s orthopedic specialty-trained models handled both office-based and surgical cases with exceptional performance, achieving up to 95% coding accuracy.
Credible, Realistic Expectations: Unlike competitors that promised unrealistic 95%+ automation rates on day one, aiHealth set a grounded goal of 20–50% touchless coding initially, a significant increase in coding productivity and throughput, while focusing on building trust and measurable ROI over time rather than selling a black-box solution.
Early Results That Matter
PELTO and aiHealth took a measured, trust-first approach to implementation, ensuring the technology delivered real value at every step. On the road to direct-to-bill capabilities, the rollout began with human-in-the-loop auditing, where coders closely reviewed AI-generated codes to validate accuracy, maintain compliance, and build confidence in the platform’s recommendations. Once accuracy thresholds were consistently met, the partnership moved to threshold-based auto-submission and productivity monitoring, allowing certain encounters to flow directly to payers without manual intervention, dramatically reducing touchpoints, turnaround times, and administrative effort. With those foundations in place, the expansion of aiHealth’s specialty-trained models was strategically planned for rollout sub-specialties such as spine, trauma, and outpatient care, unlocking significant efficiency gains and accelerating return on investment while maintaining coding quality across practice operations.
Even in the early phases, aiHealth began demonstrating tangible value:
Direct-to-Bill Capabilities: A subset of notes could now be auto-coded and submitted directly to payers without human intervention, accelerating claims submission and reducing manual workloads.
Staff Efficiency: The platform’s automation allowed coders to focus on exceptions and complex surgical encounters, helping practices avoid additional hires despite growing coding demands.
Transparency and Trust: aiHealth shared preliminary metrics openly, focusing on actionable results rather than marketing hype, building confidence among practice leaders and coders alike.
“Physician-owned and led practices, long overshadowed by large health systems, are now spearheading innovation throughout healthcare. Our collaboration with aiHealth underscores our dedication to utilizing advanced artificial intelligence to automate medical coding and enhance the efficiency of our revenue cycle.”
— Troy Simonson, CEO, Proliance Surgeons
This partnership exemplifies how innovation—applied deliberately and with purpose—can alleviate administrative strain while safeguarding the independence of specialty groups. PELTO’s approach sends a message to the broader industry: independent practices can not only adapt to economic and operational pressures, but lead the way in responsible healthcare innovation.
Learn more about how PELTO is supporting independent practices across the country: PELTOHealth.com
About aiHealth
aiHealth is a disruptor in AI-driven medical coding, pioneering autonomous coding solutions that eliminate inefficiencies in revenue cycle management for specialty practices. Its AI/ML-powered platform enhances coder productivity, reduces charge lag, and delivers unmatched accuracy in medical billing and coding. To learn more about aiHealth, visit ai-Health.io.
About PELTO Health Partners
PELTO is the modern alternative to a traditional MSO—helping private practices remain independent without sacrificing revenue, equity, or control. Physician-owned and led, we offer proven solutions spanning group purchasing, contract optimization, and strategic advisory. By uniting collaboration and innovation, we empower practices to succeed on their own terms. Founded by OrthoIndy, EmergeOrtho, and Proliance Surgeons, PELTO remains steadfast in driving transformational change that keeps providers and patients at the helm. Learn more at www.PELTOhealth.com.
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