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AI Machine Learning (ML) in RCM

        Artificial Intelligence (AI) IN RCM   
     MEASURe | MONITOR | MONETIZE

Women Owned Business Certified Logo
Women Owned Business Certified Logo

Our
Approach

P3 Quality is an Artificial Intelligence (AI) Tech company. We help facilitate quality assurance remedies for Revenue Cycle Management (RCM) and Medical Coding initiatives. Evaluating automated products, services, systems, and supply chain risks.  Identifying inefficiencies and process bottlenecks as it relates to technologies, implementations, and utilization.

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ARTIFICIAL INTELLIGENCE (AI) EXPERTISE 

We are Independent AI Audit, Governance Remediation, and Risk Advisors; we evaluate unsound inefficiencies. Challenging the Status Quo!  We Audit Heathcare, AI-RCM, and Medical Coding system patterns, trends, processes, and procedures.

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​OUR CORE VALUES

  • People, Processes & Principles

  • Human In the Loop (HITL) Supervision â€‹â€‹â€‹â€‹â€‹

 

SOLUTIONS:​​

  • Diagnose/Audit AI-Powered Readiness

  • Identify and Prioritize inconsistencies & inefficiencies

  • Capture, Analyze, & Recommend Corrective Action

  • Measure ROI & Report Success Strategies/Metrics

  • Build AI Governance & Ethical Remediation Frameworks 

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TRUSTED & UNBIASED TOOL CHEST​​​

  • CMS, MAC, HIPAA, PHI, TPA, ISO 9001, etc

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RISK REMEDIATION SERVICES

  • AI AuditME™, our Governance Remediation Framework

    • Interested in learning more about it? 

      • Contact us at info​

 

P3 QUALITY is WBE / WBENC certified and a Georgia (SBSD) Certified Small Woman-Owned Business.

Our
Methodology

 

THE AI AUDITME™ WORKFLOWS:

Methodology is Audits, Corporate, Accountable, Responsible,

and Ethical Use of AI Initiatives:

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​​​​NAIC-ALIGNED STRATEGIES:

  1. Corporate Governance and Disclosure 

  2. Transparency 

  3. Risk Mitigation and Internal Control 

  4. Regulatory Oversight | Non-Compliance 

  5. AI Third-Party Systems and Data Risks​ 

P3 FOCUS | AI PERFORMANCE GAPS

HUMAN-CENTRIC AI

We are Human-Centric AI Smart Specialists

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EVALUATING AI LLMs OR AGENTIC ERRORS​

  • AI/Automated Task Flaws

    • Data Input/Output Issues​​

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THE QUALITY/COMPLIANCE RISK IMPACT

  • Flaging AI Model risks

    • Drift​​

    • Hallucinations

    • Misfires

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AI DEFENSIBILITY 

  • Identifying/Explaining AI System Spikes

    • Algorithmic Failures 

    • ​Risk Exposure 
    • Rework

 

TYPICAL BARRIERS

  • Selective Transparency​​​​​​​​

  • AI Dependency/Trustworthiness

  • Budgetary Constraints

AuditME™ FRAMEWORK

 

AI-RCM GOVERNANCE REMEDIATION 

Automate and Regulate Checks/Balances

  • Coding/CDI Governance ​​​​​

  • Risk Exposure 

  • Compliance

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ETHICAL OVERSIGHT

  • Human-In-The-Loop (HITL) Supervision

  • Algorithmic Bias Audits & Monitoring 

  • Transparent AI & Explainability Guidelines

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STANDARD OPERATING PROCEDURES​​

Build SOP Strategies:

  • Up-to-Date SOP Manual Review or Dev

  • Human Sign Off on Patterns/Process Risks

  • AI-Driven Transparency and Accountability Reporting 

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RESPONSIBLE AI: 

  • An Internal Authority Must be Assigned as the AI Standard Bearer

    1. Set an AI Quality Bar​

    2. AI Policy Framework Ownership

    3. Bridge Operational /AI Ethics Gaps

    4. Champion Governance Across All AI Driven Functional Areas

    5. Schedule Regular Measure, and Monitor  Audit Activities

  • Implement AI Impact Assessment Requirements 

  • Codify Core AI Development Standards

  • Establish Third-Party Data & Systems Remediation Accountability​​​​

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END-TO-END
AI-RCM SOLUTIONS:  

  • Audits 

  • HITL Oversight

  • AI Maturity Modeling

  • Client Success Leadership 

  • Governance Remediation 

  • Revenue Cycle Management 

  • Patient Financial Experience  

  • Client/Payer/Vendor Intelligence 

  • Technology Vendor Landscape

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