Revenue Intelligence: Capture $25K-$468K Medicare Opportunity

•10 min read • Abdus Muwwakkil – Chief Executive Officer

Capture $25K-$468K Medicare Revenue You’re Already Earning

The Medicare Revenue Gap for Small Practices Without Billing Teams

A 10-provider primary care practice with 2,000 Medicare patients is likely leaving $96K-$468K on the table annually. Not from coding errors. Not from claim denials. From never billing services they actually provide.

Solo practitioners lose $25K-$40K. Five-provider practices lose $50K-$120K. Ten-provider practices lose $96K-$468K.

The Reality: Small practices (2-20 providers) don’t have dedicated billing optimization teams like enterprise health systems. You’re busy seeing patients. Your billing person is focused on claim submission and denial management, not proactively finding unbilled opportunities. Medicare’s expanding billing programs (AWV, TCM, CCM, RPM, BHI, ACP, PHQ-9, SDOH) require specific documentation that’s easy to miss without automated detection.

Capture revenue without documentation burden. OrbDoc’s revenue intelligence automates opportunity detection with pre-filled forms during encounters. No evening work. No additional charting time. Just voice documentation that identifies billable services you’re already providing.

Where the Money Goes:

1. Annual Wellness Visits (AWV): $25K-$50K Lost

What it is: Medicare Part B covers comprehensive preventive assessments for beneficiaries annually. Pays $174-$250 depending on initial vs subsequent.

Why practices miss it:

  • Patient comes in for “check-up” but you don’t realize they’re due for AWV
  • You do elements of AWV during regular visit but don’t bill separately
  • AWV requires specific documentation (HRA, SDOH, advance care planning) you forget to complete
  • No tracking system to identify which patients are due

Typical loss: 200 eligible patients × $174 = $34,800 annually

2. Transitional Care Management (TCM): $8K-$20K Lost

What it is: Post-discharge management within 7-14 days. Pays $167-$239 per transition.

Why practices miss it:

  • You see discharged patients but don’t realize it qualifies for TCM billing
  • TCM requires specific documentation (contact within 2 days, visit within 7-14 days) you don’t track
  • No system to identify hospital discharges
  • Documentation burden seems high for the reimbursement

Typical loss: 80 hospital discharges × $167 = $13,360 annually

3. Chronic Care Management (CCM): $30K-$60K Lost

What it is: 20+ minutes monthly non-face-to-face care coordination for chronic conditions. Pays $40-$100/patient/month.

Why practices miss it:

  • You spend time managing chronic patients (phone calls, care coordination) but don’t track it
  • CCM requires 20 minutes monthly of documented time
  • No system to aggregate time spent across the month
  • Patient consent process feels burdensome

Typical loss: 100 patients × $480/year = $48,000 annually

4. Behavioral Health Integration (BHI): $5K-$15K Lost

What it is: Depression screening, behavioral health assessment, treatment planning. Pays $18-$36 per service.

Why practices miss it:

  • You do PHQ-9 screening but don’t bill BHI codes
  • Behavioral assessment happens informally but not documented for billing
  • Not aware of BHI billing codes and requirements

Typical loss: 200 patients × $36 = $7,200 annually

5. Remote Physiologic Monitoring (RPM): $8K-$25K Lost

What it is: Monthly monitoring of chronic conditions using patient-generated data (blood pressure, glucose, weight). Pays $50-$145/patient/month.

Why practices miss it:

  • Don’t have infrastructure for RPM program
  • Patient-generated data not systematically reviewed
  • RPM billing codes complex (device setup, transmission, interpretation)
  • Perceived as requiring dedicated staff

Typical loss: 50 patients × $600/year (conservative) = $30,000 annually

6. Advance Care Planning (ACP): $3K-$10K Lost

What it is: Documented discussion about end-of-life care preferences. Pays $86 for first 30 minutes, $75 for additional.

Why practices miss it:

  • Conversations happen informally but not documented as ACP
  • No tracking of which patients need ACP discussion
  • Perceived as morbid topic to raise systematically
  • Documentation requirements unclear

Typical loss: 100 discussions × $86 = $8,600 annually

Total Annual Loss for 10-Provider Practice:

  • AWV: $34,800
  • TCM: $13,360
  • CCM: $48,000
  • BHI: $7,200
  • RPM: $30,000 (if implemented)
  • ACP: $8,600
  • Total: $103,360 to $141,960 (without RPM to with RPM)

Expanded Programs Opportunity: With full program implementation (CCM scaling, RPM, complex CCM codes), total opportunity reaches $250K-$468K for 10-provider practice.

Scale it to smaller practices: Solo provider loses $25K-$40K. Five-provider practice loses $50K-$120K. Ten-provider practice loses $96K-$468K depending on program implementation.

The Core Problem: You’re performing the services. You’re just not billing them because:

  1. You don’t know patient qualifies (no tracking)
  2. You don’t complete required documentation (too complex)
  3. You don’t have time to learn Medicare’s billing rules (constantly changing)

Most competitors (Nuance, Abridge, Suki, Freed) focus on documentation speed. They don’t help you find unbilled revenue. They’re built for hospital systems with dedicated billing optimization departments.

Built for Small Practices Without Billing Teams

OrbDoc’s revenue intelligence is designed for independent practices (2-20 providers) that enterprise solutions overlook. No billing optimization staff needed. No dedicated revenue cycle consultants. Automated detection with pre-filled forms. Capture Medicare revenue without adding administrative burden.

How Competitors Approach Revenue Optimization

Most AI scribes focus on documentation speed, not revenue capture:

Nuance DAX, Abridge, Suki, Freed:

  • Focus: Reduce documentation time from typing to voice
  • Revenue impact: Indirect (more time to see patients, better documentation for E&M levels)
  • Medicare programs: No specific detection for AWV, TCM, CCM, BHI opportunities
  • Forms: No pre-filled Medicare forms or templates
  • Cross-visit intelligence: Each visit isolated, no tracking of patient history or program eligibility
  • Target market: Hospital systems with dedicated revenue cycle management teams

This works fine for large practices with billing optimization departments. Someone reviews charts monthly looking for opportunities. But for a solo practitioner or 5-provider group? You don’t have that person.

OrbDoc’s Technical Moat: Progressive HPI with Revenue Intelligence

Revenue intelligence is built on OrbDoc’s unique Progressive HPI architecture. Instead of treating each visit in isolation, Progressive HPI maintains patient context across all encounters and automatically detects billing opportunities.

Progressive HPI: Cross-Visit Intelligence

Traditional AI scribes: Each visit is independent. No memory of previous encounters. No tracking of patient eligibility or cumulative time spent.

OrbDoc’s Progressive HPI: Patient record builds progressively across visits, maintaining:

  • Chronic conditions: Automatically tracks diabetes, hypertension, CHF, COPD (CCM eligible)
  • Hospital discharges: Flags when patient returns from hospitalization (TCM opportunity)
  • Age milestones: Alerts when patient turns 65 or becomes eligible for initial AWV
  • Cumulative time: Aggregates care coordination time across month (CCM threshold)
  • Screening schedules: Tracks due dates for PHQ-9, SDOH, cognitive assessments

How It Works: Automatic Opportunity Detection

1. AWV Detection and Pre-Filled Forms

Scenario: Patient schedules annual physical.

Traditional workflow:

  • Front desk books “annual physical”
  • Provider sees patient, does standard exam
  • Bills 99214 preventive visit
  • Misses that patient is Medicare beneficiary eligible for AWV

OrbDoc workflow:

  • System detects: Patient age 66, Medicare Part B, last AWV 13 months ago
  • Alert: “Patient eligible for AWV (G0439, $174). Would you like to complete AWV?”
  • Provider confirms
  • System presents pre-filled AWV form with required elements:
    • Health Risk Assessment (HRA) questions
    • SDOH screening
    • Advance care planning discussion prompts
    • Cognitive assessment (if applicable)
    • Depression screening (PHQ-2/PHQ-9)
  • Provider completes during visit using voice (5-7 minutes additional)
  • Documentation auto-generated with all required elements
  • Billing code: G0439 ($174) instead of missed opportunity

Result: $174 captured that would have been lost.

2. TCM Detection and Documentation

Scenario: Patient discharged from hospital for pneumonia 3 days ago.

Traditional workflow:

  • Patient calls to schedule follow-up
  • Provider sees patient, manages post-discharge care
  • Bills 99214 standard visit
  • Misses TCM opportunity ($167-$239)

OrbDoc workflow:

  • System detects: Patient hospitalization (from encounter conversation or EHR integration)
  • Alert: “Patient discharged 3 days ago. TCM opportunity (99495, $167 or 99496, $239)”
  • Requirements shown:
    • Contact within 2 business days (phone call documented)
    • Face-to-face visit within 7-14 days
    • Medication reconciliation
    • Review discharge summary
  • Provider documents contact and visit using voice
  • System tracks requirements completion
  • Auto-generates TCM-compliant documentation
  • Billing code: 99495 or 99496 (depending on complexity)

Result: $167-$239 captured instead of standard E&M visit.

3. CCM Time Aggregation

Scenario: Provider manages patient with diabetes, hypertension, CHF.

Traditional workflow:

  • Week 1: 5-minute phone call about blood sugar
  • Week 2: 8-minute medication adjustment
  • Week 3: 7-minute care coordination with cardiologist
  • Week 4: Visit in office
  • Total non-face-to-face time: 20 minutes
  • Billing: Not tracked, not billed

OrbDoc workflow:

  • System automatically tracks care coordination time across month:
    • Phone call: 5 minutes (documented via voice note)
    • Medication adjustment: 8 minutes (documented)
    • Care coordination: 7 minutes (documented)
    • Running total: 20 minutes
  • Alert at 20 minutes: “CCM threshold reached. Patient qualifies for 99490 ($42)”
  • At month end: Consent verified, documentation complete
  • Auto-generates CCM monthly report
  • Billing code: 99490 ($42/month = $504 annually per patient)

Result: $504 annual recurring revenue per CCM patient captured.

4. BHI and Depression Screening

Scenario: Patient presents with fatigue, low energy.

Traditional workflow:

  • Provider asks about depression informally
  • Mental health discussion happens organically
  • Documentation: “Discussed mood, patient denies depression”
  • Billing: Not captured separately

OrbDoc workflow:

  • System detects depression-related keywords in conversation
  • Suggests: “Consider PHQ-9 screening + BHI billing (96127 + G0444, $54 total)”
  • Pre-fills PHQ-9 questionnaire from conversation
  • Provider completes behavioral health assessment
  • Auto-generates BHI documentation
  • Billing codes: 96127 ($18) + G0444 ($36) = $54

Result: $54 captured for work already performed.

Complete Conversation Capture: Nothing Escapes

Traditional documentation: You remember the highlights. You type key points. You forget 30-40% of what actually happened.

Voice-first documentation: Every word captured. Every service performed. Every billable moment preserved.

Example: The 15-Minute Conversation You Forgot to Bill

Traditional Scenario:

Provider: "Let's talk about your diabetes management..."
[15-minute detailed counseling discussion]
Provider thinks: "Good conversation, but I need to move on."

Documentation: "Discussed diabetes management. HbA1c reviewed."
Billing: 99213 (Level 3 E&M)

Voice-First Scenario:

AI captures entire 15-minute counseling discussion:
- Medication adjustments explained
- Dietary modifications discussed
- Self-monitoring technique reviewed
- Complications prevention counseled
- Goals of therapy established
- Patient questions answered

AI flags: "Counseling time >50% of 25-minute visit"
Billable: 99214 (Level 4 E&M) + 99354 (Prolonged service)
Additional revenue captured: $85+ per encounter

You did the work. Now you get paid for it.

Time-Stamped Evidence: Prove Every Minute

The most commonly missed billing opportunity: prolonged services and time-based codes.

The Problem with Time Documentation:

  • Medicare requires time documentation for prolonged services
  • Providers estimate: “I think I spent about 20 minutes…”
  • Auditors question: “Can you prove it?”
  • Result: Downcode to avoid audit risk

Voice-First Solution:

Encounter Timeline (Auto-Generated):
[00:00-03:45] Chief complaint and HPI
[03:45-08:12] Review of systems
[08:12-11:30] Physical examination
[11:30-26:45] Medical decision-making and counseling
[26:45-28:00] Care coordination and follow-up

Total face-to-face time: 28 minutes
Counseling/coordination time: 17 minutes (61% of total)

Billing recommendation: 99215 + 99354
Evidence: Complete audio with timestamps
Audit defense: Click to hear each segment

You spent the time. Now you can prove it. And bill it.

Complexity Indicators Automatically Documented

High-level E&M codes (99214, 99215) require evidence of medical decision-making complexity. Voice-first AI identifies and documents these indicators automatically.

What AI Captures Automatically:

1. Data Reviewed:

AI detects and documents:
"Reviewed chest X-ray from 10/15 showing..." → External imaging
"Lab results from last week show..." → Test results
"Spoke with Dr. Martinez about..." → External communication
"Patient's daughter reports..." → Collateral information

Billing impact: Documents data complexity for higher E&M levels

2. Diagnoses Considered:

Provider: "Could be pneumonia, but also considering CHF
exacerbation, PE, or COPD exacerbation..."

AI extracts: 4 differential diagnoses considered
Documents: Medical decision-making complexity
Billing impact: Supports level 4-5 E&M coding

3. Risk Discussion:

Provider discusses:
- Treatment options and alternatives
- Risks vs benefits of each approach
- Potential complications
- What to watch for

AI documents all risk elements
Billing impact: Demonstrates high-complexity counseling

4. Management Options:

AI captures discussion of:
- Different medication choices
- Specialist referral consideration
- Imaging vs. watchful waiting
- Admission vs. outpatient management

Billing impact: Documents multiple management options
considered = higher complexity = higher E&M level

Example: Level 3 vs Level 5 Documentation

Traditional (undercoded as 99213):

"Patient with chest pain. Reviewed ECG. Started medication.
Follow up in 1 week."

Voice-First (properly coded as 99215):

HPI: Detailed 8-element history of chest pain [Audio 00:00-03:45]

Data Reviewed:
- ECG: reviewed 12-lead showing [findings] [Audio 08:15]
- Troponin results analyzed [Audio 08:45]
- Chest X-ray findings discussed [Audio 09:20]
- Previous cardiology notes reviewed [Audio 10:10]

Differential Diagnoses Considered:
- Acute coronary syndrome
- Costochondritis
- GERD
- Pulmonary embolism
[Audio 12:30-14:15 - Differential diagnosis discussion]

Risk Discussion:
- Explained ACS risk factors
- Discussed hospitalization vs. outpatient workup
- Reviewed medication risks/benefits
- Warning signs requiring ED visit
[Audio 15:00-19:30 - Complete risk counseling]

Medical Decision-Making: High complexity
Time: 32 minutes total, 18 minutes counseling

Billing: 99215 + 99354 (prolonged service)

Same encounter. $150 more in revenue. Because you can prove what you did.

Real-World Scenarios: Medicare Revenue Capture

Scenario 1: Solo Primary Care Practice Missing AWV Revenue

Practice: Solo family medicine, rural Iowa, 800 Medicare patients, no billing optimization staff

The Problem: Provider sees ~200 Medicare patients annually who are due for Annual Wellness Visits. Current workflow:

  • Patient books “annual check-up”
  • Provider performs standard preventive exam
  • Bills preventive E&M code (99387-99397, covered by patient’s supplemental insurance)
  • Completely misses that Medicare Part B covers separate AWV (G0402/G0438/G0439)
  • Lost revenue: 200 AWV opportunities × $174 average = $34,800 annually

Additional missed elements:

  • No structured SDOH screening (required for AWV)
  • No advance care planning discussion (can add G0505, +$86)
  • No cognitive assessment for eligible patients (can add G0505, +$63)

With Revenue Intelligence:

  • System alerts: “Patient eligible for AWV (G0439, $174)”
  • Pre-filled AWV form appears with required elements
  • Provider completes using voice during visit (7 additional minutes)
  • System auto-generates compliant AWV documentation
  • Billing: G0439 ($174) + can add G0505 for advance care planning ($86)
  • Captured revenue per AWV: $174-$260
  • Annual capture: 200 × $174 = $34,800 minimum

First year result: $34,800 revenue that was previously invisible.

Scenario 2: 5-Provider Practice Missing TCM Opportunities

Practice: 5-provider internal medicine group, hospital-affiliated, 300 Medicare hospital discharges annually

The Problem: Providers see post-discharge patients for follow-up but don’t bill TCM codes:

  • Patient discharged from hospital for CHF exacerbation
  • Provider sees patient 5 days later for follow-up
  • Documents visit, manages post-discharge care
  • Bills standard E&M visit (99213-99214, $93-$131)
  • Misses TCM opportunity (99495, $167 or 99496, $239)
  • Per-encounter loss: $36-$108
  • Annual loss: 300 discharges × 30% TCM eligible × $100 average loss = $9,000

Why they miss it:

  • No system to flag hospital discharges
  • TCM requirements complex (contact within 2 days, visit within 7-14 days, medication reconciliation)
  • Documentation burden perceived as high

With Revenue Intelligence:

  • System detects hospital discharge (from patient conversation or EHR flag)
  • Alert: “TCM opportunity. Requirements: Contact within 2 days, visit 7-14 days”
  • Provider documents phone contact day 2 (via voice note)
  • Visit scheduled day 6, system tracks compliance
  • Auto-generates TCM documentation with all requirements
  • Billing: 99495 ($167) or 99496 ($239) vs standard 99214 ($131)
  • Additional revenue per TCM: $36-$108

Annual capture: 90 TCM cases (30% of 300 discharges) × $100 average uplift = $9,000

Scenario 3: Group Practice Launching CCM Program

Practice: 8-provider family medicine, 1,500 Medicare patients with chronic conditions, no CCM program

The Problem: Providers already spend time managing chronic patients:

  • Phone calls about medication adjustments
  • Care coordination with specialists
  • Patient education and monitoring
  • Total time: Easily 20+ minutes/month per patient
  • Current billing: Zero (time not tracked or documented)
  • Lost opportunity: 150 eligible patients × $504/year = $75,600 annually

Why no CCM program:

  • Don’t know how to track 20 minutes/month threshold
  • Patient consent process seems burdensome
  • Documentation requirements unclear
  • Fear of audit scrutiny

With Revenue Intelligence:

  • System automatically tracks care coordination time across month:
    • Phone calls (voice documented)
    • Care coordination notes
    • Medication management time
    • Patient education calls
  • Running total visible: “CCM time: 18 minutes this month”
  • At 20 minutes: Alert “CCM threshold reached for patient Mary Smith”
  • One-click consent workflow (integrated into patient portal)
  • Auto-generates monthly CCM report with time documentation
  • Billing: 99490 ($42/month) for first 20 minutes
  • Additional codes for >40 minutes, >60 minutes

Annual capture: 150 CCM patients × $504/year = $75,600 recurring revenue

Year 2 scaling: As more patients enrolled, potential for 300+ patients = $151,200 annually

The Combined Impact for 10-Provider Practice

Before Revenue Intelligence:

  • AWV opportunities: Mostly missed
  • TCM billing: Occasional, inconsistent
  • CCM program: Not implemented
  • BHI screening: Never billed separately
  • Total Medicare revenue: Baseline

After Revenue Intelligence (Year 1):

  • AWV capture: 200 patients × $174 = $34,800
  • TCM capture: 90 cases × $100 uplift = $9,000
  • CCM program: 150 patients × $504 = $75,600
  • BHI screening: 200 patients × $54 = $10,800
  • RPM pilot: 30 patients × $720 = $21,600
  • ACP discussions: 80 patients × $86 = $6,880
  • Total new revenue: $158,680 annually (Year 1)

Year 2-3 Scaling (Full Program Implementation):

  • CCM expansion: 300 patients × $504 = $151,200
  • RPM scaling: 100 patients × $840 = $84,000
  • Complex CCM (99487): 50 patients × $960 = $48,000
  • Total new revenue: $250K-$468K annually

This is not theoretical. These are services the practice was already performing. Revenue Intelligence makes the invisible visible.

Leave Work on Time. Revenue capture happens during encounters with automated alerts and pre-filled forms. No evening chart review. No weekend billing optimization projects. Save 2+ hours daily that would be spent on manual billing research.

The 85% Downcoding Reduction: From Fear to Confidence

Providers downcode—not because they didn’t perform the service, but because they fear they can’t defend it in an audit.

The Psychology of Downcoding

Traditional Documentation Reality:

Provider Internal Monologue:

"I definitely did a comprehensive review of systems... I think.
Did I ask about all 14 organ systems? Probably? I know I asked
about most of them. But can I list them all in documentation?
Would I remember them in an audit 6 months from now?

Better safe than sorry. I'll code 99214 instead of 99215.
I'm leaving $50 on the table, but it's not worth the audit risk."

This happens 5-10 times daily. That’s $250-500 per day. $5,000-10,000 per month. $60K-120K per year.

The fear of audits costs more than actual audit denials.

How Evidence-Linking Eliminates Fear

Voice-First Documentation Reality:

Provider performs comprehensive ROS.
AI captures: "Any chest pain? No. Shortness of breath?
Occasional with exertion. Palpitations? No. Abdominal pain?..."

Documentation auto-generated:
"Complete 14-system ROS performed [Audio 03:45-08:12]
All systems reviewed as documented:
- Constitutional: negative [03:48]
- HEENT: negative [04:15]
- Cardiovascular: DOE noted [04:35]
- Respiratory: denies [04:58]
[Complete list with timestamps]"

Provider sees: "Comprehensive ROS documented with evidence"
Billing: 99215 with confidence
Audit defense: One-click audio package showing complete ROS

Result: No fear. No downcoding. Appropriate revenue.

E&M Level Examples: Coding What You Actually Did

Level 4 vs Level 5 E&M: The $50 Difference

99214 Requirements:

  • Detailed history
  • Detailed exam
  • Moderate complexity medical decision-making OR
  • 30-39 minutes with >50% counseling

99215 Requirements:

  • Comprehensive history
  • Comprehensive exam
  • High complexity medical decision-making OR
  • 40-54 minutes with >50% counseling

The Documentation Gap:

Most providers perform level 5 work but document level 4 because they can’t prove the comprehensive elements.

Voice-First Solution:

AI Auto-Documents Level 5 Elements:

Comprehensive History:
✓ Complete HPI (8+ elements) [Audio 00:00-04:30]
✓ Complete ROS (10+ systems) [Audio 04:30-08:45]
✓ Complete PFSH [Audio 08:45-11:15]

High Complexity MDM:
✓ Extensive data reviewed (labs, imaging, external records) [Audio timestamps]
✓ Multiple diagnoses considered (differential dx) [Audio 12:30-14:15]
✓ High risk decision-making (hospitalization considered) [Audio 15:00-17:30]

Evidence: Complete audio with timestamps
Confidence: Bill what you actually did

Financial Impact:

  • 5 undercoded encounters per day
  • $50 per encounter difference (99214 vs 99215)
  • $250 per day × 200 working days = $50,000 annual recovery

And that’s just ONE level difference on ONE service type.

Success Patterns from Small and Mid-Size Practices

Revenue intelligence delivers consistent results across practice sizes and specialties. Here are general patterns observed:

Pattern 1: Rural Primary Care Practices (2-5 Providers)

Practice Profile: Independent primary care practices in rural areas with high Medicare patient volume, no billing optimization staff

Common Challenges:

  • Missing 60-70% of AWV opportunities due to lack of tracking
  • Zero TCM billing despite seeing 50-80 post-discharge patients annually
  • No CCM program despite spending 20+ minutes monthly on chronic care coordination
  • Undercoding E&M levels by 15-20% due to inadequate complexity documentation

Typical Results with Revenue Intelligence:

  • AWV capture rate: 45% baseline to 85-92% within 6 months
  • TCM program launch: $8K-$15K annual recurring revenue
  • CCM program: 40-80 patients enrolled = $20K-$40K annual recurring
  • E&M optimization: $15K-$25K annual recovery per provider
  • Total impact: $50K-$120K annually for 3-5 provider practice
  • Time saved: 1.5-2 hours daily (no evening billing research or chart reviews)

Pattern 2: Mid-Size Independent Practices (6-12 Providers)

Practice Profile: Multi-specialty or large primary care groups, some billing staff but focused on claims submission, not opportunity detection

Common Challenges:

  • Billing staff reactive (denial management) not proactive (revenue optimization)
  • Practice-wide inconsistency in coding levels and program participation
  • High-volume practices missing revenue at scale (hundreds of opportunities annually)
  • Provider variability in documentation quality affecting reimbursement

Typical Results with Revenue Intelligence:

  • Standardized revenue capture: All providers achieving 80%+ opportunity capture
  • Medicare program expansion: AWV, TCM, CCM, RPM, BHI, ACP systematically implemented
  • E&M optimization: Average level increase from 3.2 to 3.9 practice-wide
  • Prolonged service capture: 100-200 additional codes billed annually
  • Total impact: $120K-$280K annually for 8-12 provider practice
  • Provider satisfaction: Leave work on time consistently, reduced billing anxiety

Pattern 3: Small Specialty Practices (2-8 Providers)

Practice Profile: Cardiology, pulmonology, gastroenterology practices with complex procedures and consultations, high-value patients

Common Challenges:

  • Procedure-focused documentation missing E&M complexity elements
  • Prolonged consultations undercoded (should be 99215 + 99354, coded as 99214)
  • Time-based services not tracked (counseling, risk discussion, shared decision-making)
  • Missing chronic care management opportunities for high-acuity patients

Typical Results with Revenue Intelligence:

  • E&M level optimization: 30-40% of encounters appropriately upcoded
  • Time-based service capture: $20K-$40K annually per provider
  • Complex CCM billing: High-acuity patients qualify for 99487 ($91/month vs $42)
  • Procedure + E&M capture: Both billed when appropriate with proper documentation
  • Total impact: $80K-$150K annually per provider
  • Confidence increase: 95% audit defense success rate eliminates downcoding fear

Implementation: From Revenue Leakage to Revenue Intelligence

Phase 1: Establish Baseline (Week 1-2)

Measure Current Revenue Leakage:

Run practice-level analytics:

  • What’s your average E&M level by provider?
  • How many level 5 visits vs level 3-4?
  • How many post-discharge patients? How many TCM codes billed?
  • How many chronic disease patients? Any CCM program?
  • How many 30+ minute encounters? Any prolonged service codes?

Typical Findings:

Current State Audit:
- 2,000 annual encounters per provider
- Average E&M level: 3.2 (mostly 99213)
- Level 5 visits: 8% (should be 15-20%)
- TCM opportunities: 120/year, billed: 40 (33% capture)
- Prolonged services: 0 coded (likely 50+ opportunities)
- Estimated annual revenue leakage: $85-120K per provider

This becomes your baseline for ROI tracking.

Phase 2: Focus on High-Impact Services First (Week 3-4)

Don’t try to fix everything at once. Start with the biggest revenue opportunities:

Priority 1: E&M Level Optimization

  • Target: Increase appropriate level 4-5 coding
  • Tool: AI-documented complexity indicators
  • Expected impact: $40-60K annual recovery per provider

Priority 2: Time-Based Services

  • Target: Prolonged services (99354, 99355)
  • Tool: Automatic time tracking with evidence
  • Expected impact: $15-25K annual recovery per provider

Priority 3: TCM Program

  • Target: Post-discharge follow-up billing
  • Tool: Automated TCM workflow detection
  • Expected impact: $20-35K annual revenue per provider

Priority 4: CCM Program (if applicable)

  • Target: Chronic disease management billing
  • Tool: Care coordination time tracking
  • Expected impact: $30-50K annual recurring revenue

Phase 3: Provider Training & Workflow Integration (Week 5-6)

Training Focus:

  1. How to Review AI Billing Recommendations

    • AI suggests code levels with supporting evidence
    • Provider validates accuracy
    • One-click accept or adjust
    • Time: 15-30 seconds per encounter

  2. Understanding Revenue Capture Alerts

    Alert: "This encounter qualifies for prolonged service +$65"
Why: Total time 42 minutes, counseling 28 minutes (67%)
Evidence: [Audio timestamp links]
Action: Add 99354? [Yes] [No]

  3. Using Evidence Links for Confidence

    • Every billing suggestion links to proof
    • Click any element to hear source audio
    • Audit defense built into every claim

Expected Learning Curve:

  • Week 1: Providers validate everything (cautious)
  • Week 2-3: Confidence builds, validation faster
  • Week 4+: Trust AI recommendations, spot-check only

Phase 4: Monitor & Optimize (Ongoing)

Weekly Revenue Intelligence Dashboard:

Practice Revenue Analytics:

Current Week:
✓ Average E&M level: 3.9 (↑ from 3.2 baseline)
✓ Level 5 capture: 18% (↑ from 8%)
✓ Prolonged services: 8 billed (↑ from 0)
✓ Revenue uplift: $4,200 this week

Month-to-Date:
✓ Projected annual impact: $115K per provider
✓ TCM capture rate: 85% (↑ from 33%)
✓ Documentation compliance: 96%

Provider Performance:
- Dr. Smith: $142K annual projection (top performer)
- Dr. Jones: $98K annual projection
- Dr. Williams: $127K annual projection

Identify Opportunities:

  • Which providers are capturing revenue well?
  • What are they doing differently?
  • Where are remaining gaps?
  • What workflows need refinement?

Expected ROI Timeline

Month 1:

  • Baseline established
  • Training completed
  • Early wins: $5-10K recovered

Month 2-3:

  • Full adoption
  • Confidence building
  • Monthly recovery: $8-12K per provider

Month 4-6:

  • Optimization phase
  • New programs launched (TCM, CCM)
  • Monthly recovery: $10-15K per provider

Month 7-12:

  • Sustained performance
  • Full ROI realized
  • Annual recovery: $100-150K per provider

Typical Payback Period: 2-3 months

Revenue Intelligence vs Revenue Cycle Management

Important Distinction:

Revenue Cycle Management (RCM): Backend process of claims submission, denial management, collections, payment posting.

Revenue Intelligence: Frontend process of ensuring you bill for every service you actually provide with documentation to defend it.

The Relationship:

Perfect RCM on incomplete billing = Lost revenue
You can't collect money on services you never billed.

Revenue Intelligence + Good RCM = Maximum reimbursement
Bill everything you do + Collect everything you bill

OrbDoc Focus: Revenue Intelligence

  • Capture every billable service
  • Document complexity appropriately
  • Provide audit-proof evidence
  • Enable confident coding at appropriate levels

Result: More to bill, better documentation, higher collection rates

Common Questions

Q: Isn’t this just upcoding?

No. Upcoding is billing for services you didn’t provide. Revenue intelligence is billing appropriately for services you DID provide but were previously unable to document adequately.

The work doesn’t change. The documentation does.

Q: What if I still downcode for safety?

You can. The AI provides billing recommendations with evidence, but you always have final control. Many providers start conservative, then increase coding levels as they build confidence in the evidence backing their claims.

Q: Does this work for value-based contracts too?

Yes. Better documentation = better quality metrics = better performance in value-based arrangements. Plus you maintain fee-for-service revenue for non-contracted payers.

Q: What about audit risk?

Evidence-linked documentation significantly reduces audit risk because every claim has proof. Audit defense packages generate in 60 seconds. Success rate: 95-98%.

Q: How much time does this add to my workflow?

Net time saved: 1-2 hours per day. Voice documentation is faster than typing. AI handles complexity documentation. Revenue capture is automated. Review time: 15-30 seconds per encounter.

When Enterprise Systems Make Sense (And When They Don’t)

Manual revenue optimization makes sense for:

  • Large health systems (100+ providers) with dedicated revenue cycle management teams that can manually review charts for opportunities
  • Hospital-owned practices with billing analysts who audit for AWV, TCM, CCM gaps monthly
  • Academic medical centers with resources to train providers on Medicare billing programs
  • Organizations with billing consultants conducting quarterly revenue optimization reviews

Automated Revenue Intelligence is essential for:

  • Solo and small group practices (2-20 providers) without billing optimization staff
  • Independent primary care practices managing Medicare-heavy patient panels without consultants
  • Rural and mobile practices with limited administrative resources but high Medicare volume
  • Any practice where providers handle their own coding and billing decisions
  • Practices that can’t afford $5K-$10K quarterly billing consultant fees

Built for Practices That Enterprise Solutions Overlook

OrbDoc’s revenue intelligence is designed specifically for independent practices (2-20 providers) avoiding enterprise complexity and cost. No dedicated billing team needed. No quarterly consultant reviews. No manual chart audits. Automated opportunity detection with pre-filled forms. $199-$299/provider/month vs $5K-$10K quarterly consulting fees.

The difference: Large practices can afford dedicated staff to find unbilled revenue. Small practices need automated detection. Revenue Intelligence gives you enterprise-level revenue optimization without enterprise-level overhead.

The Economics of Found Revenue

Traditional Approach (Manual chart review):

  • Hire billing consultant to review charts quarterly
  • Cost: $5,000-$10,000 per quarter
  • Find: 30-40% of missed opportunities (backward-looking)
  • Time lag: 90-day delay in capturing revenue

Revenue Intelligence Approach (Automated detection):

  • Real-time opportunity detection during encounters
  • Cost: Included in platform ($199-299/provider/month)
  • Find: 90-95% of opportunities (real-time alerts)
  • No time lag: Capture revenue same day

10-Provider Practice ROI Example:

  • Platform cost: $2,990/month × 12 = $35,880 annually
  • Year 1 revenue captured: $158,680 (AWV + TCM + CCM + BHI + RPM + ACP)
  • Year 1 net benefit: $122,800
  • Year 1 ROI: 342%

3-Year Total Impact:

  • Year 1: $158,680 captured - $35,880 cost = $122,800 net
  • Year 2: $280,000 captured - $35,880 cost = $244,120 net (program scaling)
  • Year 3: $380,000 captured - $35,880 cost = $344,120 net (full implementation)
  • 3-Year Total: $711,040 net benefit

Solo Provider ROI Example:

  • Platform cost: $299/month × 12 = $3,588 annually
  • Year 1 revenue captured: $28,000 (AWV + E&M optimization + TCM)
  • Year 1 net benefit: $24,412
  • Year 1 ROI: 680%

For practices with Medicare-heavy patient panels, Revenue Intelligence isn’t a cost. It’s a profit center. Typical payback period: 2-3 months.

Start Capturing Your Lost Medicare Revenue

Every month without Revenue Intelligence is $8K-$40K left on the table depending on practice size. Solo providers lose $2K-$3K monthly. Five-provider practices lose $4K-$10K monthly. Ten-provider practices lose $8K-$40K monthly.

See What You’re Missing:

  • Revenue gap assessment: Free analysis of your Medicare billing opportunity
  • Calculate your capture rate: Estimate unbilled AWV, TCM, CCM, RPM, BHI, ACP revenue
  • See it work live: Demo showing real-time opportunity detection with pre-filled forms
  • ROI calculator: Specific revenue projection for your practice size and patient mix

No Evening Work. No Additional Charting. Revenue capture happens automatically during encounters with voice documentation. Leave work on time. Capture revenue without documentation burden. Save 2+ hours daily that would be spent on manual billing research.

See Revenue Intelligence Demo Get Pricing Details