Revenue Cycle Management Copilot

Revenue Cycle Management

Overview

Healthcare organizations face increasing financial and operational pressures - from rising claim denials and extended A/R days to higher cost-to-collect and staff burnout.
Even with advanced billing systems, manual and repetitive processes slow cash flow,
increase write-offs, and limit visibility into performance.

Payer complexity, documentation requirements, and shifting regulations add further
friction, creating operational blind spots that existing systems alone cannot overcome.
To optimize margins and efficiency, providers need intelligent automation that enhances, rather than replaces, current tools and workflows.

Solution

Quisitive’s Revenue Cycle Management Copilot adds intelligence and automation to the revenue cycle systems you already use. Built on Microsoft Power Platform and Copilot, it automates exception tracking, documentation, and validation processes—enhancing staff productivity and accelerating collections without workflow disruption.

Solution Architecture

Built on Microsoft’s healthcare and automation frameworks, the solution leverages:

> Dynamics 365 Customer Service for case/ claim management and automated
workflows
> Azure OpenAI Service for intelligent summarization and guidance
> Copilot Studio for AI-driven prompts embedded in daily workflows
> FHIR / HL7 integration with EHR, billing, and payer systems

How It Works

1. Ingests billing and claims data from existing RCM and payer systems.
2. Applies AI-driven exception tracking to identify accounts requiring attention and guide next steps.
3. Automates documentation and validation to reduce denials and rework.
4. Embeds guided worklists and prompts within familiar billing tools to streamline
task completion.
5. Surfaces real-time insights through dashboards tracking DNFB, A/R days, cost-to-collect, and denial trends.

Outcomes

> Faster cash flow and improved collection velocity
> Reduced A/R days and administrative rework
> Lower denial rates through proactive exception management
> Enhanced staff productivity via embedded AI assistance
> Improved financial visibility with real-time dashboards and KPIs

KPIs

> A/R days reduction
> Denial rate improvement
> Cost-to-collect reduction
> Staff time saved per account
> Write-off rate decrease