Getting Oriented, your coding footprint

• How many patient encounters does your organization process in a typical month? Options: <10,000, 10,000-50,000, 50,001-150,000, 150,001-500,000, >500,000
• What percentage of those encounters require a certified coder to review the chart before claim submission? Options: 0-10%, 11-25%, 26-50%, 51-75%, 76-100%
• Describe your current coding team structure, including certified coders, reviewers, any offshore or third-party support, and typical shift coverage.
• Who owns coding accuracy targets, days-in-AR goals, and audit response on the buyer side? Options: Coding director, VP revenue cycle, HIM manager, Chief financial officer, Other
• How large is your backlog of unbilled charts today, and how has that trended over the last six months?
• What systems hold the clinical documentation, coding workqueue, and claims data your coders use today? Options: EHR, Billing system, Document management/archival, Charge capture system, Third-party coding workqueue, Other

Where it actually hurts, and the audit consequences

• If your current coding accuracy dropped by two percentage points tomorrow, what immediate financial or compliance consequences would you face?
• Tell me about the most recent payer audit or denial spike you experienced, what caused it, and how your team responded.
• In an average month, what proportion of charts require rework after coder review due to missing documentation or incorrect code selection? Options: <5%, 5-10%, 11-20%, 21-30%, >30%
• Which diagnoses or service lines generate the highest denial or audit risk for your organization? Options: Inpatient medicine, Surgery, Emergency department, Outpatient clinics, Behavioral health, Other
• Name the single failure in your current process that would make you stop a new automation project immediately.

Why the current approach keeps getting chosen

• Where has accepting a slower coding cycle become the default instead of the exception, and what hidden costs does that create for your revenue cycle?
• Who on your leadership team is most vocal about keeping manual steps, and what is their primary concern? Options: Quality assurance, Compliance risk, Headcount protection, Change fatigue, Other
• Walk me through the approval path for changing coder routing rules or introducing an automated code suggestion, from pilot to full deployment.
• Estimate the number of full time equivalents you would expect to redeploy or reduce if routine chart review were routinely automated. Options: 0, 1-5, 6-15, 16-30, 31+
• Which operational metrics would need to move within the first 90 days to justify continuing the project? Options: Coding accuracy, Days-in-AR, Denial rate, Claim velocity, Rework rate

What success looks like in practical terms

• If a pilot improved coding accuracy to your target level, which operational or financial action would you take next?
• State the accuracy target percentage you require for adoption, by code set or by service line if they differ. Options: ICD-10 >= 95%, CPT >= 90%, HCPCS >= 90%, Tiered by service line
• Specify the reduction in days-in-AR or improvement in claim velocity that would convert this from a pilot to a full roll out. Options: Reduce by 1-3 days, Reduce by 4-7 days, Reduce by 8-14 days, Reduce by >14 days
• Assuming the platform reached your threshold on a 90 day pilot, what internal approvals and sign offs would be needed to proceed to a full deployment?
• Identify the role or title that would sign the contract if the pilot proves the numbers. Options: VP Revenue Cycle, Coding Director, CFO, Chief HIM Officer, Other

Who else is on the shortlist, and why they might win

• Name the conditions that would make you choose to stay with your current approach for another year rather than switching to an external partner.
• Select the alternatives you are actively evaluating, including the incumbent, internal build, or other options. Options: Incumbent vendor, Internal build, Alternate AI coding vendor, Outsourced coding services, Process optimization with existing staff, No change / manual process, Other
• For each alternative you are considering, what is the single reason it might win over an external automation partner?
• Identify which stakeholders are advocating for an internal build instead of buying, and why. Options: IT, Coding leadership, Revenue cycle operations, C-suite, Clinical leadership, Other
• Provide the timeline you expect for vendor selection versus internal development when you compare total time to value. Options: Vendor selection 30-60 days, Vendor selection 60-90 days, Internal build 6-12 months, Internal build >12 months, Unsure
• Would an incumbent that offers fast integration but no training on your documentation patterns be sufficient to keep you with them? Options: Yes, No, Maybe, depending on risk controls

Operational readiness and gating constraints

• Point to the single integration or infrastructure constraint that would force you to delay or cancel a pilot.
• List the systems that must be reachable for a successful pilot, for example your EHR, billing system, and document archive. Options: EHR, Billing system, Claims clearinghouse, Document archive, Identity or access management, Other
• Do you have APIs available for these systems, and who owns them in your organization? Options: APIs available and owned by your IT team, APIs available but require vendor approval, No APIs, only UI access, APIs planned within 3 months, Unsure
• Rate the data readiness of your clinical documentation for model training, considering encounter structure, problem list quality, and scanned notes. Options: Pilot-ready, Mostly clean, needs mapping, Requires substantial cleanup, Scattered or scanned and needs OCR
• Provide the role and contact title of the named data steward or owner who can authorize data access and transfers.
• Are there any regulatory or compliance approvals, such as security review or data use agreements, that typically add more than 4 weeks to your timeline? Options: None, Security review only, <4 weeks, Security or legal review adds 4-8 weeks, Data use agreement adds >8 weeks, Unsure
• Point to the single technical blocker that would stop this deal today, for example lack of API access, legal restriction, or staffing shortfall.

How work would change for your people

• Point out the coding workflow step senior coders insist cannot be automated without reducing accuracy.
• Walk me through a recent chart review session from assignment to final claim submission, including tools used and handoffs.
• Choose the roles that will interact with suggested codes and documentation quality alerts during a pilot. Options: Coders, Auditors, Clinicians, Billing staff, Denial management, Other
• Describe your current chart routing by complexity or risk, who sets routing thresholds, and whether those thresholds are static or dynamic.
• Share the training, incentives, or change management supports that have proven effective when you rolled out new tooling in the past.
• Would a requirement of two hours per coder per week of retraining for three months be acceptable to your team? Options: Yes, No, Maybe with incentives or overtime coverage

Acceptance criteria and next steps that speed or stop the deal

• Specify the single metric and threshold that must be met in the pilot for you to approve a full program rollout.
• State your target timeline from pilot start to contract signature if the pilot meets the acceptance criteria. Options: Immediate, within 30 days, Within 1-3 months, Within 3-6 months, Longer than 6 months, Unsure
• Pick the internal approvals required to sign if the pilot is successful. Options: Coding director approval, Revenue cycle VP or CFO, Legal, Compliance, IT or security, Procurement, Other
• Give the title of the executive sponsor and the primary success objective they will use to judge the program.
• Will budget for a full deployment be pre-approved if the pilot meets criteria, or will you need to prepare a business case for the CFO? Options: Budget pre-approved, Requires business case to CFO, Contingent on pilot ROI, Unsure

Logistics, timing, and immediate blockers

• Tell me the earliest achievable date for a pilot start that would not compromise current operational priorities.
• Choose your preferred pilot length to evaluate value and operational impact. Options: 30 days, 60 days, 90 days, Other
• List who needs to attend the kickoff, their roles, and the minimum technical or operational prework each must complete.
• Are there any blackout dates in the next quarter that would prevent integration, data transfer, or staff training? Options: No blackout dates, Yes, specific dates provided, Yes, seasonal constraints apply, Unsure

• Solution Experience Session

• Confirm the current state and its cost
• Customer confirms the demonstrated workflow eliminates the manual rework and delayed claim submission described in Discovery.
• Run an accuracy and time-to-code comparison on the provided de-identified charts and deliver a side-by-side results report before the pilot kickoff.
• Customer agrees on measurable pilot acceptance criteria for accuracy, backlog reduction, and days-in-AR.
• Walk a real chart through your workflow
• Prepare an integration dependency checklist and preliminary field-mapping assumptions for the buyer's EHR and billing interface.
• Provide 50 de-identified representative charts covering inpatient, outpatient, and procedural encounters for training and validation.
• Customer commits to providing de-identified sample charts and named integration contacts for the pilot.
• Demonstrate accuracy and productivity proof
• Confirm acceptance thresholds for accuracy, throughput, and days-in-AR to use as pilot success criteria.
• Show integration and routing behavior in a billing scenario
• Confirm measurable acceptance criteria
• Identify named owners for coding operations and IT integration and share contact information.
• Forced validation, confirm fit

• Solution Experience Session
• Solution Experience Deck
• Solution Brief

• meeting
• slides
• document

• Deploy Code Suggestion Engine (ICD-10/CPT/HCPCS)
• Integrate with EHR Read/Write Endpoint
• Integrate with Billing and Claims System
• Migrate Historical Chart Backlog for Batch Coding
• Train Platform on Organization Documentation Patterns
• Configure Automated Chart Routing by Complexity
• Enable Documentation Quality Alerts
• Activate Denial Risk Flagging
• Deploy Coder Review Workspace and Worklists
• Enable Coder Productivity Dashboards
• Activate Audit Trail and Claim Audit Logs
• Set Confidence Thresholds and Escalation Rules
• Install Accuracy Monitoring and Reporting

Deploy Code Suggestion Engine (ICD-10/CPT/HCPCS)

• Do you intend to use the suggestion engine for real-time coder assistance at point-of-documentation versus nightly batch processing? Options: Real-time at point of documentation, Nightly batch processing, Both
• Which code sets must be activated on day one for suggested codes? Options: ICD-10, CPT, HCPCS
• How will you accept the engine's production accuracy for suggested codes (include metric, e.g., top-1 precision on sampled inpatient charts and acceptable tolerance)?

Integrate with EHR Read/Write Endpoint

• Who on your IT or integration team will provide API access and sandbox credentials for your EHR read/write endpoint and what authentication model is required (OAuth2, mutual TLS, other)?
• What EHR resources and clinical note types must be readable and writable for the integration (for example FHIR DocumentReference, Composition, discharge summary, operative note)? Options: FHIR resources (DocumentReference, Composition), HL7 v2 messages, Direct write to note objects, Attachments (PDF, CDA), Other
• Are there patient matching rules the integration must follow (MRN only, MRN plus DOB, enterprise master patient index)? Options: MRN only, MRN + DOB, EMPI match required, Other

Integrate with Billing and Claims System

• Provide the charge capture surface you need integrated (charge master updates, claim line items, remittance feed) and preferred integration method.
• List the billing transaction formats your billing system ingests or exports for claims and remits (ANSI X12 837, 835, CSV export, custom API). Options: ANSI X12 837/835, CSV batch files, Custom REST API, Database export, Other
• Identify the claim and adjudication fields we must map to preserve a full audit trail (for example charge code, service date, provider NPI, coder id, suggested code confidence).

Migrate Historical Chart Backlog for Batch Coding

• Specify the backlog size and scope you want migrated into batch coding (total charts, service lines, encounter date ranges). Options: <5,000, 5,000-25,000, 25,000-100,000, 100,000+
• Estimate the minimum migration completeness and metadata mapping accuracy you require to accept backlog migration (for example percent of charts successfully imported and percent of records with validated metadata).
• Who will provide access to archived clinical notes for the backlog and in what storage formats are those notes currently held (PDF, CCD/CDA, raw text export, EHR archive)? Options: PDF, CCD/CDA, Raw text export, EHR archive export, Other

Train Platform on Organization Documentation Patterns

• Detail the training sample set we should use (sample size by service line, inpatient vs outpatient, payer mix) for algorithm tuning on your documentation patterns.
• Indicate any local documentation variants or specialty abbreviations the model must learn (facility templates, specialty shorthand, macros) and provide examples.
• Confirm whether PHI must be de-identified prior to model training or whether training will occur under a business associate agreement with PHI allowed. Options: De-identify prior to transfer, Training under BAA with PHI access, Hybrid - de-identify subset

Configure Automated Chart Routing by Complexity

• Describe the complexity criteria that should trigger routing (for example number of comorbidities, presence of high-cost procedures, low suggestion confidence).
• Select routing destinations you require (junior coder queue, senior review, clinical documentation improvement specialist, external audit team). Options: Junior coder queue, Senior coder review, Clinical documentation specialist (CDI), External audit team
• State the target SLA for routed charts (time to first review in hours) and whether days-in-AR should affect routing priority.

Enable Documentation Quality Alerts

• Explain which documentation gaps should trigger alerts (missing HPI, absent procedure detail, unclear laterality) and how you want those severity levels defined.
• Choose preferred delivery channels for documentation alerts (in-EHR inbox, email digest, coder worklist flag). Options: In-EHR inbox, Email digest, Coder worklist flag, SMS/pager
• Report the minimum suggestion confidence threshold at which documentation quality alerts should fire to avoid excessive false positives. Options: <50%, 50%-70%, 70%-85%, >85%

Activate Denial Risk Flagging

• Identify the denial categories to be flagged for review (medical necessity, missing modifier, coding inconsistency, duplicate claims) and any payer-specific denial reasons to include.
• Is historical denial and appeal outcome data available for model tuning and what format is it in (denial reason codes, adjudication notes, CSV export)? Options: Denial codes with reason text, Adjudication notes export, CSV/Spreadsheet, Not available
• Are there payer-specific code edits or local medical policy rules that must be encoded into the denial-flagging ruleset? Options: Yes - multiple payer rules, Yes - single payer focus, No - use generic rules, Unsure

Deploy Coder Review Workspace and Worklists

• List the fields and views you require on the coder workspace (original clinical note, suggested codes with confidence, claim preview, audit trail). Options: Original clinical note, Suggested codes + confidence, Claim preview, Audit trail, Provider query tool
• Attach or describe any existing worklist prioritization logic we should replicate (for example prioritize by days-in-AR, payer, potential revenue impact).
• Select the coder actions required in the workspace (accept suggestion, edit code, create clinician query, escalate to SME). Options: Accept suggestion, Edit code, Create clinician query, Escalate to SME

Enable Coder Productivity Dashboards

• Provide the KPIs the dashboards must display (charts coded per day, accuracy rate, days-in-AR impact, denial rate) and any required calculations. Options: Charts coded per day, Accuracy rate, Days-in-AR impact, Denial rate, Coder override rate
• What grouping levels are required on dashboards (individual coder, team, service line, facility)? Options: Individual coder, Team, Service line, Facility
• Outline the reporting refresh cadence required for productivity metrics (real-time, hourly, daily) and whether exports to CSV or PDF are needed. Options: Real-time, Hourly, Daily, Weekly export only

Activate Audit Trail and Claim Audit Logs

• Name the roles or groups that require access to the claim audit logs and specify your required retention period for audit trails. Options: Coding leadership, Compliance team, Internal audit, External auditors
• How should the audit trail capture coder actions on a claim (timestamped before/after code values, user id, free-text rationale, claim id)? Options: Timestamped before/after values, User ID and role, Free-text rationale, All of the above
• Indicate any regulatory or payer audit requirements the audit logs must satisfy (for example specific retention windows or export formats).

Set Confidence Thresholds and Escalation Rules

• Specify confidence score thresholds that should determine auto-accept, coder review, and clinical escalation paths. Options: Auto-accept >90%, Coder review 60%-90%, Escalate <60%
• Choose escalation destinations for low-confidence or high-risk suggestions (senior coder, CDI specialist, clinical SME, compliance reviewer). Options: Senior coder, Clinical documentation improvement (CDI) specialist, Clinical SME, Compliance reviewer
• Estimate turnaround targets for each escalation tier (for example hours to respond for senior coder, days to close for clinical query).

Install Accuracy Monitoring and Reporting

• Which accuracy and performance metrics do you require tracked and reported (for example top-1 precision, top-3 recall, coder override rate, claim-level revenue delta)? Options: Top-1 precision, Top-3 recall, Coder override rate, Claim-level revenue delta, Denial impact
• Confirm the acceptance thresholds for ongoing monitoring that will trigger model retraining or rollback actions (for example top-1 precision drop of >5% over 30 days).
• Detail the reporting cadence and recipients for accuracy reports (for example weekly QA export to coding leadership, monthly executive summary) and required delivery formats. Options: Weekly QA export (CSV), Monthly executive summary (PDF), Ad-hoc alerts for threshold breaches

• Subscription Agreement (Order Form)
• Master Services Agreement (MSA)
• Statement of Work (SOW)
• HIPAA Business Associate Addendum (BAA)
• Data Sharing and Use Authorization
• Responsibilities and Resourcing Agreement
• Deployment Go/No-Go Criteria & Acceptance Checklist
• Service Level Agreement (SLA)
• Change Order Agreement

• Go-live Health Check (week 1-4)
• First Measurement Review (weeks 4-10)
• Acceptance Gate Review (day 90)
• Quarterly Operational Review
• Annual Value Review

• Prioritize the enhancement backlog and publish a next-quarter delivery window for each item.
• Confirm a single plan for incumbent decommissioning or read-only retention and data archival completion.
• Publish the acceptance report with pass/fail outcomes and the named buyer signatory or documented decider.
• If any criteria failed, list remediation tasks with owners and fixed completion dates for final acceptance.
• Provide evidence of incumbent system archival or read-only status and confirmation of contract/renewal handling.
• Performance trend review vs Solution Scope targets
• Confirm whether key metrics remain within tolerances defined in Solution Scope or need corrective action.
• Have a prioritized list of enhancements with target delivery windows and owners.
• Ensure ongoing training plans align with observed proficiency gaps.
• Re-confirm success criteria and owners
• Assign owners and firm resolution dates to all open operational issues.
• Schedule targeted training sessions to address observed coder proficiency gaps and confirm attendance windows.
• Annual outcomes versus Solution Scope targets
• Confirm the cumulative business value delivered over the prior 12 months relative to Solution Scope targets.
• Agree the prioritized enhancement roadmap for the next 12 months and its sequencing.
• Establish the steady-state support and escalation plan for ongoing operations.
• Produce and distribute an annual value and ROI statement with methodology and supporting data.
• Consolidate and publish the prioritized enhancement roadmap with tentative delivery quarters.
• Document the operational support contact list and escalation paths for the coming year.
• Confirm live environment is accessible and critical integrations are functioning.
• Document and prioritize any show-stopper issues with clear remediation dates.
• Ensure coder users can perform the core suggestion-and-review workflow during normal shifts.
• Publish a prioritized list of open issues with reproduction steps and target resolution dates.
• Provide a short access and configuration checklist confirming EHR and billing endpoints are reachable.
• Share initial usage logs and a short adoption summary for review before the first measurement meeting.
• Present first performance data
• Determine whether the primary KPIs are moving toward the numeric targets recorded in Solution Scope.
• Document root causes for any shortfalls and commit to remedial actions with deadlines.
• Confirm whether the project remains on track for the day-90 acceptance gate or requires schedule adjustments.
• Deliver a root-cause analysis for each metric gap with recommended fixes and target completion dates.
• Update the coder training plan to address identified workflow gaps and schedule sessions.
• Publish an updated timeline to the acceptance gate reflecting any new dependencies.
• Restate acceptance criteria and numeric targets
• Produce a documented acceptance record showing pass/fail for each numeric target in Solution Scope.
• Capture the buyer's formal acceptance decision and name the buyer signatory or documented decider.
• Deployment and integration validation
• Diagnose root causes for gaps
• Financial impact and ROI validation
• Present outcome data against each criterion
• Persistent issues and enhancement requests
• Document pass/fail per criterion and capture signatory decision
• Consolidate enhancement roadmap and multi-quarter priorities
• Agree corrective actions and timelines
• Prioritize enhancements and agree resolution windows
• Early adoption signals and usage patterns
• Incumbent system wind-down and data archival confirmation
• Blockers and open defects triage
• Handoff to operational support and escalation paths
• Confirm timeline to the acceptance gate
• Coder proficiency and training status
• Agree immediate remediation actions
• Review open action items and next steps
• Agree remediation and closeout items