Q&A: GenAI in revenue integrity

Q: How are revenue integrity departments using generative artificial intelligence (GenAI) to carry out specific functions?

A: Many organizations are considering adopting a GenAI agent in their revenue cycle. GenAI can analyze large volumes of data and generate new content in response to questions or prompts, and organizations are increasingly using it for various mid–revenue cycle functions.

When healthcare organizations use a GenAI coding agent, coders can step into more of an auditing role and focus on the challenging accounts, says Evan Martin, MBA, CRCR, EHRC, vice president of revenue cycle management at ZoomCare in Portland, Oregon.

“For example, if I have five coders on my team who need to code for 200 providers, there is no way they would be able to get through all of that work,” he says. “Introducing a GenAI agent can take the easy stuff off of their plate, leaving them to interact with the major procedures and review the GenAI agent’s recommendations.”

Another common area for GenAI implementation is CDI. Martin explains that an agent can assist with denials prevention by analyzing documentation to find commonalities. More specifically, AI can find documentation-based denial trends that trace back to specific payers, as well as consistent documentation issues linked to individual providers.

Just as AI allows coding staff to conduct more auditing work, it also helps CDI and revenue integrity professionals keep a closer eye on concerning CDI trends. When issues are identified, these teams can collaborate to engage with clinical staff and educate them on proper practices.

Organizations are increasingly using AI-powered digital scribe tools to assist providers with their documentation, which is another opportunity for revenue integrity and CDI staff to act as auditors. Such tools can greatly reduce administrative burden, but they require team members to be vigilant in ensuring all necessary documentation components are present.

Editor’s note: This answer was excerpted from “Embracing change: AI applications in revenue integrity,” in the October 2025 issue of the NAHRI Journal. The NAHRI Journal is a quarterly journal featuring in-depth analysis and expert advice and is an exclusive benefit of NAHRI membership. Not a member? Join today.