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AI and Algorithms: The Other Side of Medical Claims Processing

Written by Corliss Collins, BSHIM, RHIT, CRCR, CSM, CCA, CBCS, CPDC   

Artificial Intelligence (AI) and Revenue Cycle Management (RCM) are hot topics in the healthcare industry.  Optimizing RCM across all payment and reimbursement models can reduce overhead and improve accuracy which results in allowing your RCM workforce to focus on financial counseling and other important area requiring personal interactions with your patients and conducting pre and post documentation and coding audits.  This article addresses what Chief Financial Officers (CFOs) and other C-Suite executives needs to know about AI efficiencies and revolutionizing your RCM process.

Revenue Cycle Management Compliance

Revenue cycle management involves complex processes to manage financial transactions related to healthcare services.  Artificial Intelligence (AI) Automation and Claims Processing Algorithms for coding, billing, and payments are designed to reduce billing errors and maximize revenue recovery.  Payers are already implementing AI as a solution to deny inappropriately coded claims and detect potential fraud and abuse. 

In today’s environment, it is important for providers to increase efficiency and reduce the cost of operations, and it is the responsibility of Revenue Cycle Managers to understand and get ahead of root causes which can contribute to potential compliance issues. As we navigate some of the more common underlying causes of billing and reimbursement compliance discussed below, it becomes evident that AI and advanced technology may be a solution to consider, but what if AI algorithms don't perform as expected?

About the Author


Corliss is the founder and Chief Revenue Integrity Officer, Chief Compliance Officer of P3 Quality LLC.  She is serves as a subject matter expert and volunteer on the Education Committee for the American Institute of Healthcare Compliance.

Copyright © 2024 American Institute of Healthcare Compliance All Rights Reserved 

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