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Compliant and Effective AI Integration in Middle Revenue Cycle Functions

2 min read

As AI adoption accelerates across healthcare, internal audit (IA) leaders play a critical role in ensuring compliant, secure, and effective implementation. This AHIA whitepaper—authored by Protiviti and UASI experts—explores how healthcare organizations can responsibly integrate artificial intelligence (AI) into middle revenue cycle functions such as health information management (HIM), coding, clinical documentation integrity (CDI) and case management. 

Market Context & Opportunity

The healthcare AI market is projected to reach $45.2B by 2026, driven by rapid advancements in machine learning and natural language processing. Early use of AI in coding, documentation review and billing shows promising productivity gains, but outcomes vary and require rigorous oversight.

AI demonstrates strong potential to:

  • Automate coding for outpatient and increasingly complex inpatient cases
  • Identify documentation gaps and optimize provider queries
  • Improve accuracy and efficiency in HIM data management
  • Reduce operational costs and enhance coding quality

Key Risks in AI Enabled Revenue Cycle Processes

While benefits are significant, there are four major risk categories:

  1. Data security and privacy
  2. Regulatory and compliance risks
  3. Operational risks
  4. Ethical risks

Bottom Line

AI promises transformational value in the middle revenue cycle—but only when deployed with disciplined governance, transparency and continuous validation. Internal Audit is uniquely positioned to ensure AI enhances operational efficiency without compromising compliance, ethics or data security.

This whitepaper provides healthcare leaders with a practical roadmap to responsibly scale AI, strengthen controls and build trust in advanced automation across the revenue cycle.  It also outlines clear IA checklists, audit procedures and validation steps across several domains.

*Reprinted with permission from the Association of Healthcare Internal Auditors, Inc.

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