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RiskGen-CoreRiskGen-i

AI Won't Replace Your Coders…Here's Why You Need it Anyway

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Hemant Apte, Chief Executive OfficerAugust 15, 2025
AI Won’t Replace Your Coders

Physicians have expressed concern over payers using artificial intelligence automation, and with good reason. The AMA reports that AI tools contribute to a dizzying increase in denial rates – up to 16 times the norm [1]. So it’s only logical that many providers are looking for ways to “fight AI with AI”, especially in the area of risk adjustment services for U.S. healthcare organizations. 

Medical risk coding risk adjustment in healthcare is an excellent use case for AI solutions. When well trained, these models can improve coding accuracy – they stay on top of guidelines to support compliant coding practices, even identifying risk adjusted codes in both unstructured and structured text. It’s a huge potential benefit in supporting complete code capture. At the same time, it can grant leadership increased visibility through improved reporting and project management support – critical for effective medical coding risk adjustment operations. 

Looking at the range of potential benefits that AI offers in enhancing risk adjustment services, many leaders see an opportunity (or threat) as a replacement for human coders. This is a misguided way of looking at the technology. It’s critical to remember that, even though the work of coding is heavily numerical and structured, the complexity of medical records and the variation in documentation styles of clinicians means that a human touch is still needed. Even the best-trained AI cannot fully understand a medical record the way a certified coder can. 

This means that leaders looking for options to implement AI in risk adjustment in healthcare should move away from either-or thinking, instead taking a both-and approach to how they implement AI and human coders. This is the spirit we’ve leaned into when developing RiskGen-i our AI-powered platform for the nuances of HCC medical coding risk adjustment management. Built to complement the efforts of certified coders, this platform is an ideal solution for leaders who want to do more with the coding resources they have.

And for organizations seeking a fully human-led model, our RiskGen-Core platform delivers the same high standards of accuracy, compliance, and productivity – without AI assistance.

We invite U.S. healthcare leaders to explore how RiskGen-i and RiskGen-Core can help transform your risk adjustment services – boosting compliance, accuracy, and efficiency in today’s challenging reimbursement landscape. 

[1] American Medical Association, "Physicians concerned AI increases prior authorization denials," 24 February 2025. Available: https://www.ama-assn.org/press-center/ama-press-releases/physicians-concerned-ai-increases-prior-authorization-denials.

Hemant Apte, Chief Executive Officer

Hemant Apte is the Founder and CEO of 3Gen Consulting, a leading healthcare revenue cycle management and technology company serving providers, ACOs, and health plans across the U.S. Since founding 3Gen in 2006, Hemant has guided the company’s evolution from a boutique consulting firm into a data-driven organization at the forefront of AI-powered RCM innovation. With decades of experience in U.S. healthcare operations, Hemant continues to provide thought leadership to clients navigating financial, compliance, and technology challenges in an increasingly value-based care environment.

Is Your Risk Adjustment Team Using AI the Right Way?

Learn how AI can enhance, not replace, your coders – improving accuracy and efficiency.

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  • Audit payer contracts
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  • Protect your revenue

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FAQs

The FAQ section simplifies key information about 3Gen Consulting’s services, helping partners navigate our offerings, methodologies, and value.

Talk to an ExpertTalk to an Expert

No. AI supports coders by improving accuracy and efficiency, but certified professionals remain essential for contextual judgment.

AI tools identify risk-adjusted codes, flag documentation gaps, and ensure compliance with current CMS guidelines.

AI helps standardize coding, reduce human error, and maintain audit readiness in complex risk adjustment environments.

Adopt a hybrid model where AI platforms assist coders – improving throughput while preserving expert oversight.

RiskGen-i uses AI to optimize coding, while RiskGen-Core delivers the same precision and compliance through a human-led approach.

3Gen combines AI innovation with experienced coders to deliver accurate, compliant, and scalable risk adjustment solutions.