Healthcare agent

Coding and billing QA

Check codes against documentation and flag mismatches before claims go out.

What it does

The agent compares codes to the documentation, flags under- and over-coding, and reports what to fix. A coder makes the final call.

Without it: Coding errors drive denials and compliance risk, and manual QA cannot cover every chart.

Reviews every coded chart in the submission queue rather than a sample
Quotes the documentation line, or names the element the note is missing
Separates modifier and laterality mismatches from level-of-service disagreements
Posts findings to the QA worklist and holds no claim back itself

Illustrative example

A visit is coded 99215 and queued for submission. The agent reads the note against the payer's coding policy, reports that the documented history and exam support 99214, and quotes the two lines it read; on the next chart it reports the opposite, a laterality modifier the operative note supports but the coder left off. Both land on the coding lead's worklist, and the coder decides what changes before the batch goes out.

Reads

EHR

Notes behind each code

Coding system

Assigned codes, modifiers

Billing system

Charts queued for submission

Payer coding policy

Level-of-service rules

Runs

Coding and billing QA

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