Time-Based E/M Coding in Primary Care and Why Skipping It Leads to Undercoding

Most primary care physicians select E/M codes using medical decision making. That is one valid method. Since 2021 for office and outpatient visits, the AMA CPT E/M guidelines recognize a second, equally valid pathway: total time on the date of the encounter. Primary care practices with complex Medicare Advantage panels see the kind of long, […]

How Concurrent HCC Coding and Risk Adjustment Reviews Capture What Separate Audits Miss

When practices identify a documentation gap, the typical response is two separate reviews: one team audits E/M coding accuracy, another reviews HCC capture for risk adjustment. The problem is that both teams are reading the same chart, addressing the same underlying documentation gap, and finding only part of the picture. Chirok Health’s concurrent review addresses […]

Clinical Documentation Improvement Services for Medicare Advantage Practices That Want Accurate Risk Scores

If you’re evaluating clinical documentation improvement services for a Medicare Advantage practice, you’re past the question of whether documentation accuracy matters. The OIG has completed multiple audit series on risk adjustment data validation. CMS extrapolates RADV findings starting with payment year 2018. The question now is which CDI program will actually close the gap. The […]

What Is HCC Coding in Medicare Advantage and Why It Affects Your Value-Based Revenue

HCC coding is the process by which CMS maps patient diagnoses to Hierarchical Condition Categories to calculate risk-adjusted payments to Medicare Advantage plans. Qualifying conditions your practice documents and submits map to one of 115 payment HCCs in the current model. Those categories combine to produce a beneficiary’s risk score, and that score determines how […]

Why Cardiologists Under-Code Their Hospital Work, and What It Costs Health Systems

Cardiologists manage some of the sickest patients in the hospital: decompensated heart failure, new arrhythmias, post-procedure complications, patients on drug therapy that needs close monitoring. The documentation usually reflects that complexity. The code selected often does not. When we compared the codes cardiologists selected against the codes billed after clinical coder review at a large […]

The E/M Documentation Traps Family Medicine Keeps Falling Into

Family medicine runs on office visits, which makes E/M coding the single largest lever on both revenue and audit risk in a primary care practice. The 2021 rules were supposed to simplify it: level by medical decision making or total time, and stop counting history and exam. Five years in, the traps have not gone […]

Human Oversight in AI-Assisted Medical Coding

Purpose As organizations evaluate AI-assisted and autonomous coding, the question before leadership is not whether to adopt AI, but how to govern it. This briefing sets out why a human-in-the-loop standard should be a condition of any coding-automation deployment rather than an optional refinement. It draws on three things: the current independent research on AI […]