Audit-proof compliance for a neighborhood FQHC

A health center providing primary and urgent care, behavioral health, and dental care aimed to get a better handle on payer compliance. An administrator of the facility recognized that a clawback could jeopardize the future of the clinic, and wanted to build processes to make the practice “audit-proof.” But with just two coding staffers, getting there with manual chart review processes just wasn’t going to be possible. 

In addition to building automated workflows for closing documentation compliance gaps found on more than half of the clinic's encounter notes, Charta implemented autonomous coding analyses for guaranteeing pre-billing coding compliance. These analyses ensure that each code is adequately supported by documentation and meets payer-specific guidelines.

Autonomous review of E/M coding accuracy revealed large inconsistencies between documentation and coding. Nearly half of all encounters contained some kind of E/M leveling error: 38% of E/M codes were simply underleveled, while 16% were accurately leveled for the service, but associated documentation was insufficient to meet payer standards.

Charta also implemented additional checks to flag notes where revenue opportunities supported by the documentation were not yet coded on the chart. For example, AI analysis showed that a quarter of all encounter notes had not captured add-on codes supported by documentation. Charta engineers built automated workflows for efficiently closing these revenue gaps, helping the practice expand margins even as it scaled audit-proof compliance review across 100% of encounter notes.