Internal Medicine patients rarely present with one problem. Every comorbidity on the panel changes documentation, risk adjustment, medical necessity and reimbursement at once. This is the network that has to hold together.
Complex patients generate complex notes. Whether that note supports the code billed is the difference between clean revenue and a denial six weeks later.
Five governance checks run on every encounter, in sequence, before a claim ever reaches a payer.
Flags visits under-leveled relative to documented MDM before submission.
Unspecified codes upgraded to the most specific ICD-10 the note supports.
25, 59 and 24 sequencing checked against payer-specific edit sets.
Chronic conditions missing from this year's encounters surfaced for re-confirmation.
Every code change logged against the note that supports it, ready for payer audit.
Select a stage to see what Clientele does inside it.
A patient with three chronic conditions is due for renewal. Clientele flags every program they qualify for before the visit is even confirmed.
The wellness visit captures a full HCC review, not just vitals; every active diagnosis gets re-confirmed for the year.
Twenty minutes of non-visit care time is tracked automatically from care coordination notes, not reconstructed at month end.
Device readings feed a monitoring log that supports both the setup and the monthly management codes.
Discharge triggers a 7-day contact and a scheduled visit inside the required window, so the code isn't left on the table.
Problem-oriented follow-up is leveled against the actual MDM in the note, including data reviewed and risk.
Every code from the encounter is validated against payer edits before the claim leaves the building.
Payment posts, HCC-driven risk revenue reconciles against the model, and the panel's next opportunities are already queued.
CMS guidance sits at the center of every decision Clientele's coders make on an Internal Medicine chart.
Our HCC capture rate went up before we even asked. Nobody had proactively found that before.
CCM had been a line item on a slide deck for two years. It's now running for real, and billed correctly.
The first partner that could tell me why a complex-visit claim was denied, not just that it was.
Every active problem list is reviewed against MEAT criteria (monitored, evaluated, assessed, treated), so chronic conditions are recaptured every year instead of dropping off the risk score by omission.
We build the enrollment and consent workflow with your clinical staff, track time from care coordination notes automatically, and only bill months that clear the minute threshold, not estimates.
No, we level to what the documentation supports, with a certified coder confirming every suggestion and a full audit trail behind each code. Under-leveling to avoid audits is its own form of revenue loss.
Denials are root-caused to the specific workflow step (eligibility, coding, documentation or payer edit), and that step is fixed, so the same denial does not recur next month across the panel.
No. Clientele works inside the system you already use for documentation and scheduling; our platform layer handles coding intelligence, claim validation and analytics on top of it.
A percentage of net collections with contracted clean-claim and days-in-A/R targets. No implementation fee, and month-to-month after the first year.
