The Future of Revenue Integrity: From Reactive to Predictive - RCM

Healthcare organizations have witnessed an explosion of new opportunities to extract value from the industry’s treasure trove of data in recent years, with success stories related to using advanced technology such as artificial intelligence (AI) and machine learning found in every sector.

The scope of revenue integrity—a strategy that aims to optimize reimbursements and compliance from the outset of claim submission—originated with processes that were limited to reviewing chargemasters and making sure all codes were up to date.

Automation and analytics working in tandem with AI, natural language processing, and machine learning techniques, represent the future of revenue integrity. With the right infrastructure in place, healthcare organizations can draw the promise of a holistic revenue integrity strategy that moves beyond retrospective auditing to daily risk monitoring and more prescriptive analytics.