What we do / Charge reviewINCLUDED
Your clinicians code. We check every claim first
Your clinicians choose the codes and own the notes. Software checks each visit's codes, units and modifiers against the signed note and the insurance company's written rules. A person on your billing team reviews everything the software flags.
Who does what
Who does what in charge review
Software, checked by your billing team
Software
- Checks each visit against the note and the insurance company's rules.
- For physical therapy, also checks timed units, GP, KX and plan-of-care dates.
Your billing team
Your billing team
- Sends your clinician each documentation question with the reason.
- Fixes errors that are not clinical, such as patient details and payer IDs.
You
Your clinicians
- See patients, write and sign the notes, and choose the codes.
- Answer documentation questions and approve any change.
Charge review
Sample clinic
Sample view with synthetic data. The client dashboard is planned; this shows what it will track.
Claim C-28941
Secondary plan| Code | Service | Modifiers | Minutes | Units | Charge | Allowed | Expected |
|---|---|---|---|---|---|---|---|
| 97140 | Manual therapy | GP CQ | 30 | 2 | $156.00 | $36.58 | $36.00 |
| 97530 | Therapeutic activities | GP CQ | 15 | 1 | $90.00 | $28.82 | $28.35 |
| 97112 | Neuromuscular re-education | GP CQ | 17 | 1 | $85.00 | $22.71 | $22.35 |
| Total | 62 | 4 | $331.00 | $88.11 | $86.70 |
Expected is the allowed amount less Medicare sequestration (2% of Medicare's payment, CARC 253).
Checks before the claim went out
7 of 7 passed- Passed: 62 timed minutes = 4 units under Medicare's 8-minute rule (53 to 67 minutes).Software
- Passed: GP on every line.Software
- Passed: CQ on every line: a PTA furnished the visit. Medicare pays these lines at 85%.Software
- Passed: KX not needed: $1,298.63 of therapy this year before this visit, under $2,480.Software
- Passed: Plan of care certified Jul 15 through Sep 23; this visit is covered.Software
- Passed: 97140 with 97530 on the same day: no Medicare code-pair edit since 2020, so no 59 or X modifier.Software
- Passed: Units within Medicare's daily limits (MUE).Software
What we check
What we check, both ways
A check looks for what was billed without support in the note, and for care in the note that was never billed. Each row names who decides.
| Check | What it catches | Who decides |
|---|---|---|
| Billed but not supported | A code, unit or modifier on the claim that the signed note does not support. | Your clinician |
| Documented but not billed | Care recorded in the signed note with no code on the claim. | Your clinician |
| Units against minutes | Timed units that do not match the minutes documented in the note. | Your clinician |
| Required modifiers | A modifier the insurance company's written rules require for the service. | Flagged by your billing team; your clinician approves any change to units or modifiers |
| Specialty rules | Rules that apply to one specialty, for example plan-of-care dates for physical therapy. | Your practice gets the signatures |
| Code-pair and unit edits | Codes that do not pay together, or units above a daily limit. | Flagged by your billing team; your clinician approves any change to codes, units or modifiers |
| Missing signatures | A note that is not yet signed. | Your clinician |
- We do not change a code, unit or modifier without your clinician's approval. When something does not match, we ask.
Claims go out under your National Provider Identifier (NPI)
Medicare's enrollment form says it plainly: "Even if you use a billing agency/agent, you remain responsible for the accuracy of the claims submitted on your behalf."1 So every claim is checked against the note before it goes out.
- We do not use software to raise code levels or add units.
- We never ask a clinician to change a signed note to get a claim paid.
Coding and software
Why we never use software to raise a code
Insurers now look for claims that software pushed up. The Blue Cross Blue Shield Association says hospital AI coding tools added $942 million in spending over two years.2 We use software to catch what is missing or unsupported, and your clinician decides.
What audits find
Where Medicare finds documentation problems
Medicare samples claims it already paid and checks them against the record. These are audit findings, not denial rates.
- Medicare audit dataIn Medicare audits of established office visits, the top root cause was documentation that supports a lower level of visit than the one billed (120 sampled claims). Improper payment rates on established office visits: family practice 2.0%, internal medicine 5.7% (claims from 2023-07-01 to 2024-06-30). An improper payment rate is not a denial rate.2.0%, 5.7%
Source: CMS, 2025-113
- Example: physical therapy. Medicare audit dataPhysical therapists in private practice: Medicare improper payment rate 19.9%, and 88.3% of those improper payments were insufficient documentation (claims from 2023-07-01 to 2024-06-30). An improper payment rate is not a denial rate.19.9%
Source: CMS, 2025-113
Questions
Questions about charge review
Your billing team sends your clinician each documentation question with the reason.
We do not change a code, unit or modifier without your clinician's approval. When something does not match, we ask.
No. Your clinicians choose the codes and own the documentation. We check the codes against the note and the insurance company's rules, and ask your clinician when something does not match.
Not without your clinician. When a note and a code do not match, we ask. We do not use software to raise code levels or add units.