How AdventHealth is Using AI to Connect Clinical and Rev Cycle Teams

By leveraging AI to prioritize chart reviews and streamline physician queries, AdventHealth is bridging the gap between clinical and revenue cycle teams, driving improvements in quality metrics and cash flow.

For many health systems, clinical documentation improvement (CDI) sits at the somewhat tense intersection of clinical care and revenue cycle operations. AI has the potential to bridge that gap and drive improvements on both sides.

“When you talk through the relationship between rev cycle and clinical and quality, CDI is the department that ties it all together,” says Christopher Riccard, M.D., VP of Hospital Medicine and CDI at AdventHealth.

Prioritizing the Most Impactful Work

According to a recent survey conducted by HFMA, revenue cycle leaders indicated that CDI is a significant pain point. More than half predict that staffing for CDI roles will be difficult in the near future, and more than a quarter said CDI is causing obstacles in revenue cycle and clinical collaboration. 

These responses indicate that a core challenge for health systems is determining where to focus limited CDI resources. AdventHealth’s strategy is to use AI to identify patient records with the most to gain from CDI review. The health system partnered with Iodine to implement an AI-powered platform to help reduce manual workloads.

“The AI tool puts together a list of cases to review for our CDI team from the highest to the lowest priority based on documentation opportunity,” Riccard says.

The AI-produced worklist allows the CDI team to move beyond random chart reviews and focus on where they can have the most impact on both quality metrics and reimbursement.

Driving Provider Engagement and Reducing DNFB

The health system has also leveraged the AI platform to streamline communication and query processes between the CDI team and providers. The goal is to make it easier for physicians to respond to queries, and the results have been promising.

“While our provider turnaround time for answering questions was already strong, we still saw a decrease in the turnaround time,” Riccard said. “When we send a query to a provider, greater than 90% of the time we're able to get that query answered within one calendar day or shorter.”

This quick turnaround time directly impacts a critical revenue cycle KPI, discharged not final billed (DNFB), by ensuring charts aren't held up waiting for physician responses. By getting responses to queries faster, the health system can finalize coding and get bills out sooner, accelerating cash flow.

“If we can do anything to speed that up, it helps the rev [cycle] team because they now have the answer to the question that's pending that would otherwise hold up the chart or the bill from being released,” Riccard says.

A Proactive, Strategic Approach to AI

AdventHealth has adopted a deliberate and strategic approach to help score wins with AI in the CDI space, according to Riccard. The health system has appointed a new chief AI officer and established a formal committee to vet all new AI tools to ensure they are safe, effective, and in alignment with organizational goals.

“The goal is not to replace clinicians or revenue cycle staff, but to complement them,” Riccard says. “Technology is going to make us maybe more effective. It may help close some quality gaps that exist, some coding gaps that exist, but we're still going to need people involved in the workflows using the technology in order for us to be successful.”