Clinical Documentation Integrity in North America, 2025: Frost Radar Report

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As the healthcare industry shifts from a fee-for-service to a fee-for-value model, value-based reimbursement is becoming the standard for accountable care organizations (ACOs), independent physician practices, and non-ACO entities. This transition underscores the essential role of clinical documentation integrity (CDI) specialists, medical coders, and utilization management staff in enhancing care personalization; mitigating adverse events, such as medication reconciliation errors; and improving reimbursement efficiency.

CDI, which is an integral part of revenue cycle management, is a strategic imperative in healthcare, extending beyond its role in claims processing and denials management. It enhances patient outcomes, ensures data accuracy to reflect the true care narrative, supports precise reimbursement, and strengthens compliance risk management and revenue integrity.

As new-age CDI vendors prioritize the adoption of cutting-edge technology, such as conversational AI, AI clinical assistant in medical coding, and the use of ambient AI in clinical documentation and machine learning and natural language processing in autonomous coding, it has become imperative for electronic health record-based and legacy CDI providers to stay competitive and redefine their clinical documentation tools to support next-generation workflows across the healthcare continuum.