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 Artificial Intelligence (AI) IN RCM Quality
measure | monitoR | monetize

OUR
APPROACH

P3 Quality is a Virtual Solutions Center. We are Certified AI Professionals and Data Quality Experts who partner with our clients to deliver Quality First/Quality Forward Solutions.

 

P3 inspect, detect and correct data and process errors, inconsistencies and inaccuracies. Our solutions enhance quality, integrity and productivity! 

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Quality Control Approaches:

​AI in RCM Analysis

Algorithms and Rules Quality Review

Regulatory Quality and Governance Toolkit

Inspecting, Detecting & Assessing Inconsistencies

Leveraging Data Analytics and Reporting

Establishing a Continuous Quality Improvement Program

Determining Performance Metrics

Additional Service Offerings

Assess Outsourced Vendor Performance
Evaluated Service Level Agreements (SLA) 
SLA Metrics Review

OUR
METHODOLOGY

P3 Quality helps clients to address and resolve coding quality inconsistencies. P3 uses an end-to-end measure, monitor and monetize AI risks methodology. 

 

We leverage quality control measures to help evaluate payer and provider best practices; to ensure AI coding, regulatory requirements and standards are followed and achieves optimal reimbursement results.

Quality Control Methods:

​Measure:
Prior Authorizations, Eligibility Verification, and daily patient data reviews.

​Monitor:
Real-Time Clinical Documentation Integrity (CDI), AI in Medical Coding (i.e., ICD-10, CPT & HCPCS) data integrity/charge integrity and reconciliation auditing.

​Monetize:
Claims Management, and Denials Management mitigation and remediation.

ON DEMAND
SERVICE OFFERINGS

AI in REVENUE CYCLE MANAGEMENT (RCM) 
What is AI in RCM exactly?

P3 Quality Eyes are on AI!​​​ AI in revenue cycle management (RCM) is a transformative force that harnesses advanced technologies like machine learning, natural language processing (NLP), and robotic process automation (RPA) to revolutionize and enhance the RCM Administrative and Claims management process.  

Examples: 

Scheduling/Pre-Registration Errors

Incomplete Insurance Verifications 

Procedure Code Inaccuracies

Charge Integrity Issues

Timely Filing Deadlines Missed

Denials Not Tracked or Monitored

Policies/Procedures Not Clearly Defined

​​AI in MEDICAL CODING
What about AI in Medical Coding?

​AI in medical coding refers to the use of machine learning algorithms, natural language processing (NLP), and automation tools that are used to analyze clinical documentation, extract relevant information, and assign accurate codes for billing purposes.

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Are you seeing a 95 to 97% accuracy rate when using AI Medical Coding software? If not, how are you identifying, addressing and correcting errors and inconsistencies? 

Examples: 

Incorrect Code Use

Quality and Compliance Discrepancies

System Integration Compatibility Issues 

Training and Adaptability Challenges

Vendor Performance 

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