After · claim submittedChart Audit
The finding points at a line.
5Chief complaintChest pressure on exertion
The level billed rests on line 5Chest pressure on exertion
Both directions
Revenue left in the chart, and exposure left on the claim.
Recoverable
In the provider's favourWhat the note supports, and was not billed
FindingBilledSupported
Work documented, never capturednot billed99406
A level below what the note carries9928399284
Level, unbilled servicesKinds of finding
Your codersConfirmed by
Exposure
Against the claimWhat was billed, and the note does not support
FindingBilledSupported
A diagnosis coded as establishedI24.9R07.89
Unspecified where the note is specificE11.9E11.65
A level above what the note carries9928599284
Level, diagnosis, specificityKinds of finding
ComplianceConfirmed by
An audit that only finds overcoding is a compliance tool, and one that only finds undercoding is a revenue tool. Every finding is a draft for your coders and compliance team to confirm.
What sits under a finding
What is real, what is derived, and what we do not have.
- RealThe chart
The clinical document itself, read in full.
- RealThe billed code
Taken from the claim line, never inferred from the note.
- DerivedThe discrepancy
The level the documentation supports, set against the code billed.
- ModeledThe dollar figure
Medicare RVUs against an industry-average multiplier. A magnitude, not a contracted amount.
- AbsentWhat was paid
No remittance data is taken in, so no finding says what was actually paid.
How a level is derived
The rules a reviewer applies, on a chart you can change.
Medical decision making sets an emergency department level: two of its three elements decide it, and time is never used. Choose a chart.
Medical decision making
Emergency department · two of three elements set the level
| Element | Straightforward | Low | Moderate | High |
|---|---|---|---|---|
| Problems | One minor problem | One stable chronic illness | Acute illness with systemic symptoms | Threat to life or bodily function |
| Data | None or minimal | Two unique tests | Three unique tests, or one interpretation | Two of those categories |
| Risk | Minimal | Over-the-counter advice | Prescription drug management | Decision to admit or escalate |
| ED code | 99282 | 99283 | 99284 | 99285 |
Problems high, data high, risk high. Two of the three are enough; here all three agree.
HighProblems
HighData
HighRisk
99285ED code
From chart to finding
Seven steps, and one of them is refusing to answer.
Traced back
A finding, followed back to the door.
When an encounter runs on V3ra from intake onward, the line a finding rests on was written at the door, read by Clinical Intelligence while the encounter was open, and accepted by the physician. Nothing was re-entered on the way, so the trail does not break.
Illustrative
5Chief complaintChest pressure on exertion
AcceptOverrideDefer
Dr. Michael Zorch · 10:42
During · encounter openClinical Intelligence
Read it while the encounter was open and still correctable.
How the analysis works5Chief complaintChest pressure on exertion
Differential, assembled3 cited
Coding, deriveda draft
At the doorThe patient
Said it once.
5Chief complaintChest pressure on exertion
“Pressure in my chest when I climb stairs.”
Traced back, from the audit to the door
The trail is the record itself.
Send a sample. See every finding with its source.
- 01A BAA is signedBefore any chart moves.
- 02You send completed encountersNotes and the claims billed on them.
- 03We walk through each findingWith the line in the chart it rests on.