The Dark Side of AI We see the same mistakes over and over again in Artificial Intelligence (AI) and Revenue Cycle Management (RCM) projects: data drift, misaligned KPIs, and weak governance. An example of issues that shrink projected revenue and create quality and compliance risks on implementation projects is provided below: Drift and Decay: The AI Model Gets Worse Silently The Pitfalls:   Teams launch new AI models and forget about them. The environments begin to change ov

AI Audit Ready RCM AI is reshaping revenue cycle management (RCM)— but is it compliant? We provide a concise set of guardrails to make sure your AI-driven RCM is audit-ready. Start with immutable audit trails that record AI decisions, data sources, and model versions. Require regular bias and fairness assessments that cover demographic and payer-related impacts. Maintain documentation standards: data lineage, validation results, change logs, and approved use cases. Map AI out

This American Institute of Healthcare Compliance (AIHC) article, written by Corliss Collins and Dr. Tami M. Harris, takes a clear-eyed look at healthcare interoperability—what’s working, what’s not, and why it matters now more than ever. While interoperability promises better data exchange, improved care coordination, and operational efficiency, it also introduces real challenges around system fragmentation, artificial intelligence, data governance, security, and accountabili

The AI Algorithm Drift Grift Is the AI Algorithms Drift issue a Grift? No. Artificial Intelligence (AI) Algorithmic Drift itself is NOT a grift — but the way some vendors handle the issues associated with AI Drift, (or hide it) absolutely can be . Algorithm drift is a real, well-documented technical phenomenon  in machine learning. Drift itself is a legitimate science. For those who might be pondering what a Grift is? An AI in RCM Grift refers to a kind of hustle that exa

Why Are AI In RCM Denials Increasing? According to Fortune Business Insights, the global AI Market was valued at $29 billion in 2024. The USD AI market is expected to grow from $39.25 billion in 2025 to $504.17 billion in 2032, yet, despite all of the AI-driven technological advancements in Revenue Cycle Management (RCM), hospitals had more than $260 billion of initial claims denied in 2024, and over $20-plus billion was spent fighting denials. Why aren't these AI-powered t

The adoption of AI in Clinical Documentation Integrity (CDI) is rapidly changing how health systems capture, interpret, verify, and validate patient information, medical codes, and charges in the modern healthcare ecosystem. However, while AI promises unprecedented levels of efficiency and accuracy, one challenge remains at the forefront: explainability . Explainability ensures that the logic behind an AI’s decisions, recommendations, and inferences can be clearly understood,

In the world of revenue cycle management (RCM), artificial intelligence (AI) is no longer a futuristic experiment—it is baked into everything from prior-authorization checks to claims, denial prediction, operational dashboards, clinical documentation integrity (CDI), coding assistance, and audit support.  When AI supply chains collide with hallucinations, they confidently produce  incorrect or fabricated outputs. In RCM, mistakes can cost money, damage reputation, and lead to

The Next Legal Frontier in the AI Supply Chain Artificial Intelligence is transforming every layer of modern business—from finance and cybersecurity to healthcare and patient services. But as organizations integrate AI through third-party systems, APIs, and cloud vendors , they may also be inheriting hidden liability. The question is not if  something will go wrong. But, when something goes wrong, who will be responsible?    The Expanding Web of AI Responsibility AI no longer

When AI fails to deliver the promised ROI, issues identified within the service line should be audited, stabilized, or claw back value...

The AI Coding Assistant promises faster chart reviews, fewer denials, and leaner staffing. On paper, the Return on Investment (ROI) looks...

The promise of AI in healthcare lies in its efficiency and effectiveness. The risk? Denials without due process.   In Medicare today, the...

On this Veterans Day , we acknowledge and celebrate two exceptional men in our family, Willie C. Pittman ( who is no longer with us ) and NaQuarn K. Evans ( who is currently a student at Morehouse College ). We recognize, celebrate, and honor both of you for your sacrifice. We also honor and celebrate "All of the other men and women who have served, and those who are continuing to serve in the United States Armed Forces,” whose blood, sweat, tears, and sacrifice have helpe

What Was Predicted (2020) In October 2020, the World Economic Forum forecasted that by 2025, automation and AI would displace 85 million...

🚨  One Minute Read: The Hidden Dangers of Untrustworthy Clinical Documentation Integrity (CDI) Automation. According to an IBM | Read in...

🔍 Overview Artificial Intelligence (AI) in medical coding promises increased efficiency, accuracy, and scalability. However, adopting...

The primary goal  of Correct Coding Initiative (CCI) edits  is to prevent improper payments  by ensuring that medical coding follows...

Introduction We Salute You in the Spirit of Acknowledging and Celebrating all of the Brilliant and Talented women experts who are...

Introduction Artificial intelligence (AI) is revolutionizing medical coding by automating code assignments and improving billing...

Introduction A concerning pattern has emerged as healthcare organizations increasingly turn to automated systems for medical coding...

Introduction As Artificial Intelligence (AI) transforms healthcare revenue cycle management (RCM) and medical coding, understanding and...