AI Governance in Healthcare RCM
Artificial intelligence (AI) is transforming healthcare revenue cycle management (RCM) by driving new process efficiencies, improving data integrity and delivering a more seamless patient experience. All of this leads to healthier cash flow and better patient care. So it is paramount that providers partner with vendors who have established highly effective and forward-thinking protocols that are centered on building and deploying responsible AI. R1 stands at the forefront of this AI governance commitment, with a continual and unwavering focus on AI that is framed by responsible governance and ethical standards.
Responsible AI governance
As the World Health Organization (WHO) explained in its recent guidance document, ensuring safety, transparency, reliability, fairness, ethics and privacy in AI applications is not just best practice; it is an institutional imperative.
Corey Perman, executive vice president and chief compliance and risk officer at R1, emphasizes the importance of ethical AI and the need to be good stewards of this powerful technology.
“Our true north is to be compliant and ethical in everything we do, making the right decisions for the right reasons,” says Perman. “Our commitment to operating with integrity, transparency and accountability is front and center across our global delivery, and our approach to building and deploying AI is no different. We lead with the best people, ideas and technology to create responsible, ethical AI that simplifies complexity for our clients and the industry.”
Balancing innovation with ethics
In the race to innovate, maintaining ethical standards is paramount. AI in healthcare offers vast potential, but it must be balanced with a strong ethical framework. R1’s governance framework is built on checks and balances, ensuring that every AI application aligns with ethical principles. This approach not only safeguards patient and customer data but also fosters trust among stakeholders.
A principles-based governance
R1’s governance framework is anchored by responsible AI principles – safety, transparency, reliability, fairness, ethics and privacy. These principles guide our policies and standards, regardless of the tools we use to optimize revenue for our clients.
“All of the same rules, standards and considerations apply – patient privacy, accuracy of transaction processing, delivery of services and outcomes – they all remain the same,” says Sean Radcliffe, executive vice president and general counsel at R1.
Our innovation is grounded in objective standards, ensuring that every AI-powered product undergoes rigorous review for compliance and ethical alignment. What does that mean at R1? Our approach to all technology, including AI, is that it must have certain characteristics:
- Valid, reliable and robust: AI systems perform consistently and accurately, with mechanisms for regular auditing and validation.
- Safe, secure and resilient: AI systems do not cause harm and are deployed in a way that protects users and data.
- Transparent, explainable and interpretable: AI processes and decisions are understandable to stakeholders, so customers know how their data is used and how AI-driven outcomes are produced.
- Privacy focused: Sensitive data, including patient and customer information, is managed in compliance with regulations like HIPAA.
- Fair and bias-managed: Equitable, bias-free outcomes across different populations and use cases.
To reinforce these principles, R1 established an AI governance committee, comprised of experienced leaders with deep expertise in privacy, data protection, compliance, legal, technology and healthcare operations. The committee regularly reviews use cases to ensure alignment with company principles and acts to check-and-balance development before new AI products or features are rolled out.
” We are an industry leader in identifying and solving complex challenges with a compliance-first approach grounded in ethical, responsible actions,” says Perman of R1 innovation. “Our approach to AI follows that same path, with know-how and commitment to developing and delivering AI solutions where compliance, ethics and responsible governance are built-in, critical elements of our solutions.”
Human oversight in AI implementation
Despite AI’s independent decision-making capabilities, human oversight of AI remains a crucial ingredient in adoption. Humans play a vital role in auditing AI outputs, ensuring accuracy and maintaining ethical standards. Building a great AI tool for healthcare requires expertise in RCM, knowing how operators think and work, not just assessing what can be easily automated. R1 emphasizes a “humans-in-the-loop” approach, ensuring that AI serves as a tool to enhance human capabilities rather than replace them.
Leading the way in AI governance
R1 is at the forefront of AI governance in healthcare RCM, setting the standard for ethical deployment and responsible use. Our commitment to safety, transparency and accountability empowers healthcare professionals to harness AI’s potential while safeguarding patient interests. As AI adoption accelerates, R1 remains dedicated to leading the industry with integrity and innovation.
