Frequently asked questions

1. What do you do in one sentence?

I advise healthcare organizations on how to evaluate and adopt artificial intelligence responsibly within risk adjustment, coding, and revenue cycle operations while protecting compliance, revenue integrity, and organizational credibility.

2. Who is an ideal client for you?

Health plans, hospitals, multi-site provider groups, revenue cycle management organizations, and healthcare leaders who want to evaluate AI technologies used in risk adjustment, HCC coding, and operational workflows before implementation.

3. What is the “Digging for Diamondz” consultation?

It’s a complimentary 20-minute strategy session where we identify potential risks, operational gaps, and opportunities related to AI adoption, risk adjustment workflows, and organizational strategy.

4. Do you implement AI tools or only advise?

My primary role is strategic advisory. I help organizations evaluate AI technologies, assess operational and compliance risks, and determine whether automation tools align with coding integrity, revenue cycle operations, and long-term financial performance.

5. Are your services HIPAA-compliant?

Yes. My advisory work is conducted with a governance-first mindset, emphasizing data protection, vendor evaluation, and compliance awareness when organizations are considering AI solutions.

6. Will you put PHI into AI tools?

No. Any evaluation of AI technologies prioritizes privacy protection and regulatory awareness. I strongly recommend testing tools using de-identified or synthetic data during evaluation phases.

7. What results can we expect from AI evaluation?

Organizations gain clarity around automation risks, coding accuracy exposure, and operational readiness. The goal is to ensure AI tools strengthen documentation integrity, risk adjustment accuracy, and revenue cycle performance.

8. What is a Brand RX™ Audit?

Brand RX™ is a strategic evaluation of your organization’s positioning, messaging credibility, compliance alignment, and visibility in highly regulated healthcare markets.

9. Do you only work with healthcare?

Healthcare is my primary focus, particularly organizations involved in risk adjustment, coding, and revenue cycle operations.

10. What makes you different from other consultants?

I combine more than two decades of experience in medical coding, billing, and risk adjustment with expertise in healthcare marketing and artificial intelligence strategy. This allows me to evaluate AI technologies through the lens of compliance, revenue integrity, and operational reality.

11. How long does a typical engagement take?

Short advisory assessments may take two to four weeks. Larger strategic evaluations or pilot frameworks can take six to twelve weeks depending on organizational needs.

12. Do you publish pricing?

No. Each engagement is customized. After the Digging for Diamonds consultation, clients receive a detailed scope outlining the evaluation process, timeline, and investment.

13. Which systems and platforms do you work with?

I align with major EHR and healthcare technology platforms while evaluating AI tools used for documentation analysis, risk adjustment coding, workflow automation, analytics, and operational insight.

14. Can you train our team?

Yes. I provide training and advisory guidance for leadership teams, coding professionals, and operational staff on AI literacy, governance considerations, and responsible automation practices.

15. Do you work outside Georgia?

Yes. Advisory services are provided remotely and on-site across the United States.

16. How do we get started?

Begin by scheduling a Digging for Diamondz consultation. From there, I may recommend an AI Risk Assessment, Risk Adjustment Technology Evaluation, or Brand RX™ strategic review.

17. What is AI in risk adjustment coding?

AI in risk adjustment coding refers to artificial intelligence tools designed to analyze medical records, identify potential Hierarchical Condition Categories (HCCs), and assist coding teams in reviewing documentation that may impact Risk Adjustment Factor (RAF) scores.

18. Can artificial intelligence improve RAF scores?

AI may help organizations identify documentation patterns and potential coding opportunities more efficiently. However, RAF performance ultimately depends on accurate clinical documentation and compliant coding practices. AI should support coding teams, not replace professional coding judgment.

19. What risks do AI tools introduce in risk adjustment programs?

When implemented without proper evaluation, AI tools can introduce risks such as incorrect suspect condition identification, documentation interpretation errors, workflow disruption, and increased exposure during RADV audits. Strategic evaluation is critical before integrating AI into coding workflows.

20. How does AI impact RADV audit exposure?

If AI tools generate coding recommendations that are not fully supported by clinical documentation, organizations may face increased vulnerability during Risk Adjustment Data Validation (RADV) audits. Ensuring documentation integrity and coding compliance remains essential.

21. How should healthcare organizations evaluate AI vendors for risk adjustment?

Healthcare organizations should evaluate AI vendors by examining documentation interpretation methods, coding compliance alignment, workflow integration, audit defensibility, and operational readiness. Strategic review before adoption helps prevent costly implementation mistakes.

22. Should AI replace human coders in risk adjustment?

No. Artificial intelligence should function as a support tool that enhances coder productivity and data analysis. Certified coding professionals remain essential for ensuring accurate interpretation of clinical documentation and compliance with coding guidelines.