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AI the Pathway to Mid-Revenue Cycle Management Success 


P3 was conceptualized over a decade ago as an internet-based  Knowledge Center designed to share information on how Generative AI is changing how we approach Mid-Revenue Cycle Management (MRCM) issue resolution. 


P3 helps to bridge the gaps between Human Collaboration, Artificial Intelligence (AI) Automation, and Transformative Initiatives as they relate to Revenue Integrity (RI) and Health Information Information (HIM) Operations Dynamics.   



In RI, one of the tasks that we focus on is making sure charges are hard coded on the Charge Description Master (CDM) to ensure Charge Capture Integrity, Billing, and Claim Reimbursement Best Practice are achieved.  

AI-Powered Automation impacts Revenue Integrity Operations in a number of ways:  

  • It helps to streamline processes 

  • Identifies and helps to address charge accuracy and efficiency issues

  • Contributes to long-term Financial Sustainability 


HIM Operations allow us to provide Indirect Patient Care for healthcare organizations.  We help to improve the Quality of Revenue Cycle Management standardization protocols. 

AI-Powered Natural Language Processing (NLP) tools can extract unstructured clinical notes and documents:

  • AI Algorithms can help to improve data accuracy and the speed of how Medical Records are retrieved

  • Automated Coding Systems can assign the appropriate diagnosis and procedure codes of patient care services that help to create the medical billing statement.


Keeping an eye on AI and its impact on RI!


Artificial Intelligence algorithms and automation have demonstrated significant value in RI and HIM.  AI can help to streamline coding, billing, and claims processing.  

However, there are AI Automation Xceptions to success:  


  • Human Collaboration, Claims Review, Work Queue (WQ) Prioritization, Predictive Analytics

  • Inaccurate or Incomplete RI or HIM data sets can lead to incorrect AI Predictions.

  • AI Prediction errors in technical, operational, clinical, and financial spaces? 



P3 examines Human and AI Collaboration; it is important to find the appropriate balance between Human RI / HIM expertise and AI Automation. 


Understanding how AI  functions can be very challenging.  

Overreliance on AI or resistance to its recommendations can have both positive outcomes and negative consequences.  

The P3 Approach to AI, RI, and HIM Automation:

  • Assess Current State

  • Develop policies and procedures 

  • Review and draft roles and responsibilities standards

  • Serve as an Interim to support Future State Change Management Initiatives 



P3 evaluates AI Xceptions and their impact on RI CDM Maintenance, Charge Capture Integrity, HIM, and other Revenue Cycle Management (RCM) operational structures.



  • MRCM Charge Integrity

  • Revenue Integrity (RI) Metrics

  • CDM Auditing

  • Charge Capture Integrity

  • Charge Reconciliation 

  • Pre-Bill Edit Management

  • HIM and Revenue Integrity

  • Pre/Post EHR Implementations

  • Work Queue Maintenance

  • HIPAA Privacy & Interoperability

20 Minute Consultation

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