Revenue Cycle Optimized: Defending Revenue When Payers Use AI

Payers are increasingly using AI to scan claims, flag anomalies, and trigger denials or audits automatically—often without transparency and long before anyone on the hospital side understands what happened. As these systems accelerate, hospitals face growing exposure, especially when documentation, data flow, and internal AI tools aren’t aligned with how payer models interpret clinical and financial information. This session unpacks the mechanics behind automated decision-making, why even accurate claims can be flagged, and how missing audit trails or inconsistent documentation can undermine appeals. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/