Governance, Risk, and Compliance in Healthcare Revenue Cycle

By TTP HEALTH | May 2025

TTP HEALTH understands that India’s healthcare landscape is increasingly shaped by large-scale government health schemes—like the Pradhan Mantri Jan Arogya Yojana (PMJAY), Central Government Health Scheme (CGHS), and others. These initiatives present tremendous opportunities, but they

also come with complex claim workflows, high compliance expectations, and constant scrutiny.

Most hospitals try to solve revenue leakage with faster billing or more staff. But the TTP HEALTH VIEW is different:

Real transformation in Revenue Cycle Management (RCM) comes from integrating Governance, Risk, and Compliance (GRC)—and AI-powered automation—into the core of hospital financial operations.

Why Traditional Revenue Cycle Approaches Are No Longer Enough

Hospitals often experience:

• - Frequent claim rejections due to poor documentation or missed deadlines
• - Manual bottlenecks in preauthorization, coding, and appeals
• - Low visibility into claims across departments
• - High dependency on limited staff for documentation and follow-ups
• - Financial losses from audit penalties and unclaimed dues

TTP HEALTH’s GRC + AI Framework for Modern RCM

1. Governance: Elevating Revenue Accountability

integrating Governance, Risk, and Compliance (GRC)—and AI-powered automation—into the core of hospital financial operations.

Why Traditional Revenue Cycle Approaches Are No Longer Enough

Hospitals often experience:

• - Frequent claim rejections due to poor documentation or missed deadlines
• - Manual bottlenecks in preauthorization, coding, and appeals
• - Low visibility into claims across departments
• - High dependency on limited staff for documentation and follow-ups
• - Financial losses from audit penalties and unclaimed dues

TTP HEALTH’s GRC + AI Framework for Modern RCM

1. Governance: Elevating Revenue Accountability

- Assigning ownership across the entire claims lifecycle.
- Creating RCM leadership dashboards with denial trends, realization rates, and turnaround time (TAT) metrics.
- Establishing governance councils to review performance and escalate delays.

2. Risk Management: AI-Powered Early Detection

- AI bots monitor real-time data to flag high-risk claims.
- Predictive models highlight possible preauthorization delays or coding mismatches.
- Risk registers link operational issues (e.g., delayed discharge) to financial outcomes.

3. Compliance: Scheme-Specific, Tech-Enabled SOPs

- Rule-based AI engines ensure compliance with scheme-specific protocols.
- AI revi

partments

TTP HEALTH’s GRC + AI Framework for Modern RCM

1. Governance: Elevating Revenue Accountability

- Assigning ownership across the entire claims lifecycle.
- Creating RCM leadership dashboards with denial trends, realization rates, and turnaround time (TAT) metrics.
- Establishing governance councils to review performance and escalate delays.

2. Risk Management: AI-Powered Early Detection

- AI bots monitor real-time data to flag high-risk claims.
- Predictive models highlight possible preauthorization delays or coding mismatches.
- Risk registers link operational issues (e.g., delayed discharge) to financial outcomes.

3. Compliance: Scheme-Specific, Tech-Enabled SOPs

- Rule-based AI engines ensure compliance with scheme-specific protocols.
- AI reviews documentation against submission checklists.
- Pre-submission audits are automated to reduce human error.

AI Agents in Action: Transforming the RCM Lifecycle

Function                                                                            AI Agent Role

Eligibility Verification                                                    Auto-checks insurance status and alerts for mismatches

Preauthorization                                                           Gathers required documents, submits requests, tracks approvals

Medical Coding                                                             Suggests accurate International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes,

                                                                                       checks compliance

Claims Submission                                                       Validates data, formats claims for different payers

Denial Management                                                    Categorizes rejections, drafts appeals, and tracks resolutions

Payment Posting                                                         Auto-matches payments, flags underpayments or variances                             

What Hospitals Achieve with GRC + AI in RCM

- Up to 25% faster claim realization                   - 30–50% reduction in denials           - 70–90% automation of repetitive RCM tasks
- Real-time insights for Chief Financial Officers (CFOs) and medical directors          - Improved audit preparedness and lower financial risk

A Strategic Shift, Not Just a Software

This isn’t about installing another tool. It’s about redesigning your revenue cycle with structured governance, proactive risk controls, compliance discipline, and intelligent automation.

TTP HEALTH helps hospitals move from reactive firefighting to predictive, data-driven, and compliant revenue management.

Hospitals Can’t Afford to Wait

With rising claim volumes, more scrutiny from scheme auditors, and increasing staff costs, hospitals that don’t adapt will continue losing revenue.

Those that integrate GRC and AI into their RCM processes will be the financially sustainable, patient-focused, and audit-ready leaders of tomorrow.

Let’s Build a Revenue System That Works

Triple Top Pattern Health Pvt Ltd (TTP HEALTH)
Your Partner for Clean Claims, Smarter Hospitals, and AI-Enabled Financial Operations

Email: info@ttphealth.in
Phone: +91 82333 93456
Website: www.ttphealth.in

Let’s automate the routine, govern the process, and reclaim lost revenue—together.