Code Reconciliation System
Automated Chart-to-Billing Compliance & Audit System — Automated chart-to-billing reconciliation engine that cross-validates clinical documentation against billing claim codes to identify missed CPT codes and prevent revenue leakage.
The Compliance & Revenue Challenge
In large-volume clinical practices, discrepancies between doctor chart narratives and recorded billing CPT codes cause severe revenue leakage and compliance risks. Manual reconciliation took 5 to 12 minutes per chart, creating huge backlogs.
Intelligent Cross-Matching Engine
Developed an asynchronous reconciliation engine that cross-validates clinical procedures mentioned in physician progress notes against final billing claim submissions. The engine automatically flags missing modifier codes, unbilled procedures, and documentation gaps.
Operational Savings
Processed batches of ~4,300 charts in bulk, saving 135+ staff hours per batch (1.88 minutes per chart saved). Cut review latency by 10x (down to 30s–1m), allowing billing teams to resolve high-priority discrepancies proactively.