Case Studies

“We thought our billing was fine.”

A solo internal medicine practice in Florida. ~700 encounters a month, 8,500 patients on the books, mostly Medicare. One provider, one MA, a small front desk. They had a biller. Claims went out. Payments came in.

But nobody was asking: are we getting paid what we should be?

The visit that changed everything

A patient comes in for a follow-up. They’re on oxycodone, alprazolam, and gabapentin — all controlled substances. They have hypertension, diabetes, and chronic pain. The provider manages all of it in one visit.

That visit was billed as a 99213 — low complexity. $78 reimbursement.

Under 2021 E/M guidelines, managing a controlled substance with 3+ chronic conditions is moderate medical decision-making. That’s a 99214 — $110 reimbursement.

One visit. $32 left on the table. Nobody noticed.

We noticed. Our AI Code Review system read that note, identified the controlled substance management, counted the chronic conditions, and flagged it: “This documentation supports 99214. You billed 99213.”

Then we checked the rest. Out of 260 encounters reviewed, 35 had the same problem — 13.5% of visits were undercoded. Projected across a full year of 7,200 encounters: $31,000 in revenue the practice was simply not collecting.

But that’s only half the story. The same system found 168 encounters going the other direction — billed at 99214 where the note might only support 99213. That’s not lost revenue. That’s audit risk. $148,800 in potential exposure that nobody was tracking.

One tool. Two problems solved. The provider didn’t change a thing about how they document.

The front desk that drove $76,000 in revenue

Annual Wellness Visits pay ~$118 each. They’re the backbone of MIPS quality scoring. But patients don’t call to schedule their own wellness exam — and without a system telling the front desk who’s due, those appointments never get made.

We gave the front desk a dashboard. Every morning: 10 tasks. Not vague reminders — specific patients who need specific things done today.

Schedule Mrs. Johnson for her AWV. Flag Mr. Rodriguez for depression screening. Call Mrs. Chen about her medication renewal.

They didn’t need training. They didn’t need a new workflow. They just opened the list and worked it.

846 Annual Wellness Visits completed that year. $76,509 in revenue that wasn’t happening before. Every one of those visits also counted toward MIPS quality measures — which directly increased the ACO bonus.

The same dashboard enforced depression screening, medication reconciliation, and care team documentation at every visit. Quality reporting codes started going out consistently. The practice went from patchy MIPS compliance to the highest score they’d ever achieved.

Their ACO bonus baseline was $50,000/year. Every point of improvement adds real money — and this practice hit metrics it had never hit before.

The no-shows that started paying for themselves

Patients no-showed. It happened every week. It was in the chart. But nobody had time to manually apply the fee, generate the statement, and track whether it got paid.

We automated it. No-show happens → fee applied → statement sent → tracked.

$46,375 in no-show fees charged. $14,767 collected. That’s not a lot per incident — but it adds up to real money over a year, and it was money that used to simply disappear.

What it added up to

From a practice that thought billing was “fine.”

The front desk opens the dashboard each morning. The biller reviews flagged encounters each week. The provider documents exactly as before. Same people. Same workflows. More revenue. Less risk.