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AI-RCM ERRORS
WHAT AI CAN GET WRONG
Patient Access/Registration
Demographics, coverage, guarantor, plan selection, eligibility interpretation
Eligibility/Benefits
Verification
Incorrect benefit interpretation, deductibles, coverage status, authorization requirements
Prior Authorization Systems
Incorrect procedure criteria, payer rules, medical-necessity determinations and authorization status
Clinical Documentation Integrity (CDI)
Unsupported diagnoses, missed diagnoses, incorrect clinical indicators, or severity assumptions
Computer Assisted Coding (CAC)
Incorrect ICD-10-CM, ICD-10-PCS, CPT, HCPCS, modifiers and E/M levels
Charge Capture Systems
Missing charges, duplicate charges, incorrect units or services
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