About Us

Built From the Inside of a PI Practice — Not the Outside Looking In.

Most medical consulting agencies are run by administrators or business generalists who have never treated a PI patient or faced a defense billing challenge. PAID is different.

PAID was founded by Dr. Rishi Agarwal, a board-certified anesthesiologist and pain management specialist who built and currently operates his own PI lien-based practice — Ascension Pain Specialists — with locations in Pasadena, CA and Alpharetta, GA.

Clinical excellence in PI medicine is only half the equation. The other half is building systems that produce defensible documentation and billing infrastructure that sustains a practice through lien-based reimbursement. Most specialists enter the PI space without those systems. PAID builds them.

To give PI specialist physicians the documentation and billing infrastructure they need to protect their work product and recover its full value at lien resolution — built by a physician who has navigated the same system from the inside.

A PI medical ecosystem where specialist physicians compete on the quality of their clinical care — not on whether their documentation survives a defense expert’s scrutiny. Too many skilled physicians lose lien value not because their care was inadequate, but because their systems were. PAID exists to close that gap.

Physician-first accountability. Every recommendation we make is one Dr. Agarwal applies to his own practice.
Precision over volume. PI medicine rewards specificity. We build specialty specific systems, not generic templates.
Clinical credibility as the standard. Documentation that can’t withstand defense scrutiny isn’t documentation — it’s liability.

About Our Founder

Dr. Agarwal is the founder and physician consultant at PAID. His clinical background spans anesthesiology and interventional pain management, with procedural expertise across the in- office and facility-based procedures common in PI lien medicine. His practice, Ascension Pain Specialists, operates exclusively on a lien and cash-pay basis.

What distinguishes Dr. Agarwal’s perspective is that it is not theoretical. He understands what documentation must convey to survive a defense IME, how to structure fees to remain defensible under California’s reasonable value standard, and how documentation quality directly determines lien resolution outcomes. When PAID clients consult with Dr. Agarwal, they are accessing that knowledge directly — from a physician still in the PI trenches alongside them.

Our Philosophy

PI medicine rewards precision and punishes ambiguity. Thin psychiatric documentation gives a defense IME room to minimize symptoms. An incomplete operative report hands defense counsel a narrative. A neurosurgeon’s lien gets cut when there’s no billing rationale to counter the defense expert.

These are not clinical failures. They are documentation and systems failures — and they are preventable. Every system in a PI specialist practice should be designed to protect the physician’s work product and maximize its recoverable value at resolution. That is what PAID builds.

Our Philosophy

Who We Work With

PAID works exclusively with PI-focused specialist physicians operating on a lien or cash basis — pain management, orthopedic surgery, neurosurgery, physiatry, neurology, and psychiatry. We do not serve general practitioners, hospital systems, or non-PI specialties. That focus is intentional. The documentation standards, billing dynamics, and lien resolution mechanics of PI medicine are specific enough that generalist consulting produces generalist results.

Who We Work With