Every payment integrity recovery, denial, and appeal eventually comes back to one place: the clinical documentation in the medical record. For payer PI teams that are still building out or scaling up, understanding how documentation is created, queried, and finalised before it ever reaches a claim is the single most useful foundation you can lay. RCX works on both sides of that fence, supporting hospital CDI programs and payer DRG validation reviews, and this panel brings together payer PI leaders and clinical documentation experts who have spent their careers inside the chart. The goal: help attendees build review programs that recover real dollars, hold up under appeal, and don't burn out their provider relationships in the process.
- How clinical documentation actually gets created, queried, and finalised on the provider side, and the DRG families where new PI programs should focus first
- What "defensible" looks like in a DRG validation or documentation-driven review, and how to design reviews that recover dollars without destroying provider relationships
- Where AI fits for a team just starting out, and what data and governance you need before turning it on
