Queue
7
encounters in active review
Revenue Cycle Copilot · Coding / CDI / Revenue Integrity
AI-assisted prebill review for hospital encounters
Review charts that need documentation clarification, coding cleanup, or denial-risk intervention. The model proposes the work, explains why, and lets the team keep the final decision.
Revenue at risk
+$19,760
recoverable across filtered queue
Manual review time
2h → 2h
estimated after accepted changes
Quality lift
93.1%
0 denial risks directly addressed
Filters
Encounter queue
Documentation and coding review
Selected encounter
LM · Cardiology
70s · Dr. Shah · 2.8 day LOS · Medicare Advantage
Risk score
92
Revenue at risk
+$4,820
Clinical notes
Progress note: patient required IV diuresis and telemetry monitoring after cath.
Cardiology note documents NSTEMI and acute systolic heart failure with pulmonary edema.
Hemoglobin dropped from 11.2 to 8.9 after procedure. Transfusion not given.
Discharge summary
Discharged home after PCI. Symptoms improved with diuresis. Continue dual antiplatelet therapy and follow up in 1 week.
Procedures and diagnoses
Procedures
- Coronary angiography
- Drug-eluting stent placement
Diagnoses
- NSTEMI
- Acute systolic CHF exacerbation
- Acute blood loss anemia
Payer review rules
Acute systolic heart failure requires clear treatment and monitoring support for higher-severity coding.
Post-PCI inpatient stay requires medical necessity language when observation is converted.
Revenue cycle copilot
Transparent recommendations
Human review required
ICD specificity93% confidencepending
Capture acute systolic heart failure severity
Upgrade unspecified CHF wording to acute systolic heart failure based on treatment already documented.
Revenue
+$1,880
Suggested action
Why the model suggested this
- • Cardiology note documents acute systolic heart failure and IV diuresis.
- • Telemetry monitoring and pulmonary edema support higher specificity.
Evidence and audit trail
- • Cardiology consult 04/13
- • Medication administration record
- • Chest imaging impression
CDI query86% confidencepending
Clarify post-procedural blood loss anemia
The chart supports anemia after PCI, but the diagnosis is not clearly linked in the discharge summary.
Revenue
+$1,240
Suggested action
Why the model suggested this
- • Hemoglobin decline and procedure timing support acute blood loss anemia.
- • Discharge summary omits whether anemia was clinically monitored.
Evidence and audit trail
- • CBC trend
- • PCI op note
- • Discharge summary
Denial risk90% confidencepending
Observation-to-inpatient rationale is weak
Payer may challenge inpatient conversion without explicit medical necessity language.
Revenue
+$1,700
Suggested action
Why the model suggested this
- • Chart shows conversion after cath, but the physician note does not explicitly explain why observation was insufficient.
- • Payer policy requires severity + intensity language.
Evidence and audit trail
- • Admission order
- • Utilization review note
- • Payer policy excerpt
Physician clarification
Drafted query
Keep physician outreach concise, auditable, and tied to the exact missing clinical fact.
Before / after impact
Operational value on this encounter
Manual review time
21 minfrom 21 min
Denial risk
31%from 31%
Coding accuracy
92.4%from 92.4%
Accepted history