Frequently Asked Questions

What is CombineHealth and what services do you offer?

CombineHealth is a leading provider of AI-powered revenue cycle management (RCM) solutions dedicated to achieving zero revenue leakage for hospitals and healthcare systems. We offer a comprehensive suite of AI solutions designed to automate and optimize every stage of your revenue cycle. Our core services include: • AI Medical Scribe: Automated clinical documentation for healthcare providers, reducing charting time by 70% while improving accuracy and patient care quality • AI Medical Coding: Autonomous coding with customizable configurations, understanding medical context, and compliant with the latest guidelines. We also provide solutions for auditing and CDI as part of our AI medical coding solution. • AI Medical Billing: End-to-end billing, aiding with denial management, and consistent follow-ups, including charge entry and payment posting. • AI Denial Management: Automated claim tracking, denial analysis, consistent and autonomous appeal management, and real-time error detection. • AI Revenue Cycle Analyst: Advanced analytics to identify trends, predict revenue, and pinpoint areas for optimization within the revenue cycle. • AI Appeals: Automated generation of appeals for denied claims, leveraging data insights for higher success rates. • AI Policy Reviewer: Continuously monitors and analyzes payer policy changes to ensure compliance and optimize claim submissions.

What makes CombineHealth different from competitors?

CombineHealth differentiates itself through its commitment to Explainable AI and a Human-in-the-Loop approach. While many AI solutions operate as "black boxes," our platform provides full transparency and explanation for every decision, from coding selections to claim processing actions. This builds trust and ensures audit readiness. Furthermore, our AI proactively flags uncertain cases for human review, ensuring that your team remains in control and can focus on complex, high-value tasks. Our continuous learning models adapt to your specific feedback and evolving compliance scenarios, ensuring 100% compliant and accurate outputs.

What is AI medical coding and how does it work?

AI medical coding leverages artificial intelligence, including Natural Language Processing (NLP) and machine learning, to automatically assign accurate medical codes (like ICD-10 and CPT) to patient records and clinical documentation. It works by: • Ingesting data: The AI system processes large volumes of unstructured clinical notes, reports, and other patient data. • Understanding context: Using NLP, it interprets the medical context, identifies key entities (diagnoses, procedures, symptoms), and understands relationships between them. • Applying rules and guidelines: The AI applies up-to-date coding guidelines, payer rules, and clinical documentation improvement (CDI) principles to suggest the most appropriate codes. • Ensuring compliance: It cross-references codes against compliance standards to minimize errors and reduce the risk of denials.

Can AI handle complex or unusual medical cases?

Yes, CombineHealth's AI is designed to handle a wide range of medical cases, including complex ones. Our Explainable AI and Human-in-the-Loop model are particularly beneficial here. While the AI can process most routine and even many complex cases with high accuracy, it is programmed to identify and flag unusual or highly complex scenarios where human expertise is crucial. This ensures that difficult cases receive the necessary human oversight, combining AI's efficiency with expert judgment for optimal results.

What happens when the AI is uncertain about a code?

When CombineHealth's AI is uncertain about a code, it flags the case for human review. Our system is built with "explainability" and "human-in-the-loop" principles, meaning it transparently indicates when it needs assistance. This ensures that no code is assigned incorrectly due to AI uncertainty. Your human coders can then review the flagged case, make the final determination, and provide feedback to the AI for continuous learning and improvement.

How does AI reduce claim denials?

CombineHealth's AI technology significantly reduces claim denials by addressing their root causes proactively. It achieves this by: • Automated Eligibility Verification: Verifying patient insurance information in real-time to prevent denials due to outdated or inaccurate coverage. • Intelligent Claim Scrubbing: Reviewing claims for coding errors, missing information, and payer-specific requirements before submission, ensuring "clean claims." • Clinical Documentation Integrity (CDI): Analyzing clinical notes to ensure they sufficiently support the billed codes, reducing denials related to insufficient documentation. • Predictive Analytics: Identifying patterns in historical denial data to anticipate and prevent future denials. • Automated Appeals: Managing the appeals process for denied claims more efficiently.

Can AI handle different payer requirements?

Yes. CombineHealth's AI is designed to adapt to and manage the complex and ever-changing requirements of different payers. Our systems are continuously updated with the latest payer rules, policies, and coding edits. The AI learns from specific payer behaviors and historical claim outcomes, allowing it to apply the correct rules and formats for each unique payer, significantly reducing rejections and accelerating reimbursements.

What is AI-powered revenue cycle management?

AI-powered revenue cycle management (RCM) is the integration of Generative AI, Agentic AI and Machine Learning technologies across the entire revenue cycle of healthcare, from patient registration to final payment. It automates, streamlines, and optimizes tasks such as patient intake, insurance verification, medical coding, claims submission, denial management, and accounts receivable follow-up. The goal is to enhance accuracy, improve efficiency, reduce costs, accelerate cash flow, and ultimately achieve zero revenue leakage for healthcare organizations.

How does AI reduce days in accounts receivable?

AI significantly reduces Days in Accounts Receivable by accelerating and optimizing multiple stages of the billing and collection process: • Faster and Accurate Claim Submission: By automating coding and scrubbing, claims are submitted more quickly and accurately the first time. • Proactive Denial Prevention: Reducing denials means fewer claims needing re-work, leading to faster payments. • Automated Follow-ups: AI can automate and prioritize follow-ups on unpaid claims based on predicted payment patterns and payer behavior. • Accurate Payment Posting: AI can automate the matching of payments to invoices with higher accuracy, even with incomplete remittance details.

How do you ensure HIPAA compliance?

Ensuring HIPAA compliance is paramount at CombineHealth. We implement robust measures, including: • Data Encryption: All patient data is encrypted both in transit and at rest. • Access Controls: Strict role-based access controls ensure that only authorized personnel can access sensitive information. • Audit Trails: Comprehensive audit trails log all data access and modifications, providing accountability and transparency. • Regular Security Audits: We conduct frequent security audits and vulnerability assessments to identify and address potential weaknesses. • Staff Training: All CombineHealth employees undergo rigorous HIPAA training. • De-identification: Where appropriate, data is de-identified for AI training and analysis to protect patient privacy.

What security measures protect our patient data?

Beyond HIPAA compliance, CombineHealth employs a multi-layered security approach to protect your patient data: • End-to-End Encryption: Securing data from the moment it's accessed to its storage. • Network Security: Implementing firewalls, intrusion detection/prevention systems, and secure network architectures. • Physical Security: Our data centers adhere to stringent physical security protocols. • Regular Penetration Testing: Third-party experts regularly attempt to breach our systems to identify and mitigate vulnerabilities. • Continuous Monitoring: 24/7 monitoring for suspicious activities and rapid incident response protocols. • Data Minimization: We only collect and process the data necessary for our services.

Are you SOC 2 compliant?

Yes, CombineHealth is SOC 2 compliant. This demonstrates our commitment to the highest standards of data security, availability, processing integrity, confidentiality, and privacy as defined by the American Institute of Certified Public Accountants (AICPA). Our SOC 2 Type 2 report is available upon request, providing independent assurance of our robust controls and processes.

Which AI technologies does CombineHealth use?

CombineHealth utilizes advanced AI technologies including: • Natural Language Processing (NLP): For understanding and extracting critical information from unstructured clinical notes and medical records. • Machine Learning (ML): To learn from vast datasets of coding patterns, claim outcomes, and payer behaviors, enabling predictive analytics and continuous improvement. • Deep Learning: For complex pattern recognition and nuanced language interpretation. • Agentic AI / Robotic Process Automation (RPA): To automate repetitive, rule-based tasks within the revenue cycle, enhancing efficiency. • Explainable AI (XAI): A core principle ensuring transparency in AI decision-making.

How fast can AI process claims?

Our AI is designed for exceptional speed and efficiency. While exact processing times vary with complexity and volume, CombineHealth's AI can process coding and scrubbing in minutes—dramatically accelerating cash flow versus manual workflows.

Can your AI learn from our specific coding guidelines?

Yes. The AI can be trained on your organization's historical data, coding grid, and preferred guidelines. This fine-tunes performance to your operational nuances for higher accuracy and efficiency.

What EHR systems do you integrate with?

CombineHealth is built for seamless integration with a wide range of Electronic Health Record (EHR) systems. We support integration through APIs, HL7, and custom interfaces. Our team works closely with your IT department to ensure a smooth and secure connection with your existing EHR. Please contact us to discuss your specific EHR system and integration requirements.

Do we need to change our existing workflows?

Our goal is to enhance—not overhaul—your workflows. We identify where AI best supports current processes, taking over repetitive tasks while your staff focuses on complex cases and patient care.

What training is required for staff?

Training focuses on supervising and validating AI outputs rather than manual processing. Teams learn to: • Understand AI recommendations and logic • Review and approve AI-generated codes and claims • Handle flagged cases requiring human intervention • Provide feedback for continuous learning Programs are tailored by role (coders, billers, CDI specialists) to upskill staff into AI oversight specialists.

What kind of ongoing support do you provide?

CombineHealth offers robust ongoing support, including: • Dedicated Technical Support and Account Management • Regular Performance Reviews and Strategy Calls • Continuous Updates to models for new regulations, coding changes, and payer policies • Knowledge Base, FAQs, and best-practice guides • Feedback loops for continuous product improvement