Your annual number
What your charts leave behind
Fee-for-service
$261,000
Coding depth and missed visits both move money here.
PPS and wrap
$342,000
Missed visits only. Coding a visit more completely doesn't change the encounter rate.
- Fee-for-service undercoding 3,000 undercoded visits at $35 $105,000
- Fee-for-service visits that never happened 1,200 missed follow-ups at $130 $156,000
- PPS visits that never happened 1,800 missed follow-ups at $190 $342,000
This is a model of the cost of doing nothing, built on published industry figures. It isn't a projection of Scribe-X results.
How this is calculated
Every line, in plain language
Three components, each one a multiplication you can check by hand. Your payer mix decides which column a leak lands in.
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Fee-for-service undercoding
visits per year × fee-for-service share × % undercoded × dollars left per undercoded visit
Coding depth only changes what a fee-for-service claim pays, so this line is scoped to your fee-for-service visits.
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Fee-for-service visits that never happened
referrals and recalls ordered × % never completed × fee-for-service share × average fee-for-service reimbursement
A follow-up nobody worked is a visit that never got scheduled, and the revenue that would have come with it.
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PPS visits that never happened
referrals and recalls ordered × % never completed × PPS share × PPS rate per visit
Under the prospective payment system the encounter pays a flat rate, so documenting a visit more completely doesn't raise it. That's why this column counts nothing but visits that never happened. It's the honest version of the number, and it's usually still the bigger one.
For context
Three published figures worth knowing
42%
of Medicare evaluation and management claims were coded incorrectly, adding up to $6.7 billion in improper payments in one year.
HHS Office of Inspector General, analysis of 2010 Medicare claims (OEI-04-10-00180).
$40,000
per provider, per year, in prevention and care coordination work that gets delivered and never billed.
Annals of Internal Medicine, 2022. A modeled ceiling, not observed collections.
1.6%
aggregate operating margin across community health centers in 2023, with nearly half operating at a loss.
2023 Uniform Data System data, via KFF and the GWU Geiger Gibson program.
What to do with your number
Bring it to a 20 minute conversation.
Automation drafts the documentation and a trained Remote Healthcare Assistant finishes it, so the work arrives ready to sign instead of waiting on a provider. Bring your three lines and we'll walk through where that lands against them.