Frequently asked questions

1. What do you do in one sentence?

I audit healthcare organizations’ risk adjustment and coding practices while evaluating AI-assisted workflows to identify unsupported diagnoses, detect overpayments, and reduce compliance risk.

2. Who is an ideal client for you?

Healthcare organizations, Medicare Advantage plans, hospitals, and revenue cycle teams that need clarity on coding accuracy, compliance exposure, overpayment risk, and the impact of AI on their operations.

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

It’s a complimentary 20-minute session where we identify potential risks in your coding practices, documentation, and AI-assisted workflows to determine whether your operations are accurate, compliant, and defensible.

4. Do you implement AI tools or only evaluate them?

I do not implement AI tools. My role is to audit, evaluate, and govern AI-assisted processes to ensure they are accurate, compliant, and aligned with regulatory expectations.

5. Are your services HIPAA-compliant?

Yes. All evaluations are conducted with a compliance-first approach, ensuring data protection, privacy awareness, and alignment with regulatory standards.

6. Will you use PHI in AI tools?

No. Any evaluation of AI systems prioritizes privacy and compliance. AI tools should be tested using de-identified or controlled data environments.

7. What results can we expect from an audit or evaluation?

Organizations gain clarity on unsupported diagnoses, coding inconsistencies, overpayment risk, and whether their processes—including AI-assisted workflows—are compliant and audit-ready.

8. Do you still offer Brand RX™ audits?

Brand RX™ has evolved. The focus is now on evaluating credibility through compliance, revenue integrity, and operational accuracy within healthcare organizations.

9. Do you only work with healthcare organizations?

Yes. My work is focused specifically on healthcare organizations involved in risk adjustment, coding, and revenue cycle operations.

10. What makes you different from other consultants or auditors?

I combine over 20 years of medical coding and risk adjustment experience with AI governance expertise, allowing me to evaluate both human and AI-driven processes through the lens of compliance, accuracy, and revenue integrity.

11. How long does a typical engagement take?

Focused audits typically range from two to four weeks, while more comprehensive evaluations and governance assessments may take six to twelve weeks depending on scope.

12. Do you publish pricing?

No. Each engagement is customized based on the level of risk, scope of evaluation, and organizational needs identified during the initial consultation.

13. Which systems and platforms do you work with?

I evaluate coding practices and workflows across major EHR systems and AI tools used in documentation review, risk adjustment, and revenue cycle operations.

14. Can you train our team?

Yes. I provide training for coders, billers, and leadership teams focused on coding accuracy, compliance, and validating AI-assisted outputs.

15. Do you work outside Georgia?

Yes. Services are provided nationwide, both remotely and on-site as needed.

16. How do we get started?

Start with the Digging for Diamondz™ consultation to assess your current risk and determine the appropriate next steps.

17. What is AI in risk adjustment coding?

AI in risk adjustment refers to tools that analyze medical records and suggest diagnoses or HCCs. These tools must be carefully validated to ensure all recommendations are supported by clinical documentation.

18. Can AI improve RAF scores?

AI may identify patterns, but RAF accuracy depends on compliant coding and supported documentation. AI should assist—not replace—professional coding judgment.

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

AI can introduce risks such as unsupported diagnoses, documentation misinterpretation, and increased audit exposure if outputs are not validated and governed.

20. How does AI impact RADV audit exposure?

If AI-generated diagnoses are not supported by documentation, organizations may face increased vulnerability during RADV audits, including potential recoupments.

21. How should healthcare organizations evaluate AI vendors?

Organizations should evaluate AI tools based on documentation accuracy, compliance alignment, audit defensibility, and the ability to support—not replace—coding professionals.

22. Should AI replace human coders?

No. Certified coders are essential for validating diagnoses, interpreting documentation, and ensuring compliance. AI should function as a support tool, not a replacement.