Vantage Coding audits real urgent care charts against the 2021+ MDM framework — by provider, visit type, and driver. Structured deliverables. No ongoing commitment required.
A single downcode from Level 4 to Level 3 costs approximately $50 per visit. Across five providers seeing 30+ patients daily, the annual leakage becomes significant — and nobody is measuring it.
The documentation is typically there. Prescription drug management, acute illness with systemic symptoms, external records reviewed, independent historian — these MDM drivers are routinely present in the chart but absent from the code selection.
Without an independent review, the pattern becomes institutional. No payer will ever send additional reimbursement for complexity that was documented but not billed.
Both the OIG and CMS recommend that all providers have their coding reviewed by an independent party with appropriate expertise, on a regular basis. Independent reviews serve to identify errors before they become embedded in organizational practice.
— OIG Compliance Guidance for Individual and Small Group Physician PracticesEach encounter is scored on the three MDM elements — number and complexity of problems, data reviewed, and risk of management — using the 2021+ framework. Code selection is based on documentation, not billing history.
The audit identifies which specific MDM drivers — Rx drug management, acute illness with systemic symptoms, external note review, independent historian — are most commonly present but uncaptured in code selection.
Results are segmented by individual provider to show where the pattern is concentrated. This allows targeted follow-up education rather than a broad, unfocused training initiative.
Overall findings, agreement rate, and a clear recommendation on whether a focused implementation pilot is warranted.
Agreement rate, undercoded rate, overcoded rate, and accurate rate across all reviewed encounters.
Individual provider variance analysis with coding patterns, accuracy rates, and the specific visit types affected.
Identifies which MDM elements are most commonly documented but not reflected in the billed code level.
Conservative, assumption-stated estimate of annual compliant revenue being left uncaptured, with stated reimbursement assumptions.
A 45-minute meeting to walk through findings, answer questions, and arrive at a go / no-go recommendation together.
A 15-minute call to verify provider count, chart access path, decision-maker availability, and whether the audit scope applies to your group.
Engagement letter, BAA, and invoice. The 10-day turnaround clock starts only after chart access and required data are confirmed.
125 encounters audited against the 2021+ E/M framework. Billed code, supported code, and driver flags recorded for each chart.
Full deliverable package plus a 45-minute leadership readout with a clear recommendation on whether to proceed.
This is an accuracy product, not a "bill higher" product. The review flags overcoding as well as undercoding. Revenue estimates are conservative and clearly state assumptions. If the audit finds no meaningful gap, that is still a useful outcome — you get a documented baseline and avoid investing in a pilot that wouldn't move the needle.
A one-page diagnostic that covers the most common indicators of a Level 3 → Level 4 gap — from code distribution skew to documentation patterns that suggest missed MDM drivers.
RCM platforms process claims efficiently — but they don't audit the clinical reasoning behind the code. The gap between what's documented and what's billed is invisible to the billing workflow.
The ~$50 per-visit difference between 99213 and 99214 compounds fast. A look at how the gap forms, why it persists, and what the typical annual impact looks like for a 5-provider group.
OIG compliance guidance explicitly recommends independent coding reviews. A summary of the relevant guidance and what it means for urgent care operations leadership.
A short discovery call to confirm provider count, chart access path, and whether the scope applies. No commitment required.