Every line. Every code. Every dollar — translated.
of internist claims are undercoded.
Not rejected. Not denied. Just quietly short. Your E/M level was documented correctly and billed one level too low. Clarity shows you exactly where, and exactly how much it costs.
average annual revenue lost per internist to modifier errors alone
Your billing isn't broken.
It's just speaking the wrong language.
A 99214 documented as a 99213. A procedure that needed a -25 modifier filed without one. These aren't catastrophic errors — they're quiet ones. Multiplied across a panel of 800 patients, they become the revenue gap you can't explain at year-end.
Clarity reads your claims history the way an experienced biller does — except it flags every pattern, names every payer rule, and tells you in plain English what to fix and what to refile.
Real example, anonymized
A solo internist in her third year of practice was filing 99213 for 71% of her established patient visits. Her documentation supported 99214 in 58 of those cases. Annual difference: $31,200.
Payer by payer.
Code by code.
Denial patterns aren't random. They follow payer-specific rules that most billing software never checks.
Medicare
18.4%
denial rate
Medical necessity not documented for E/M level billed
UnitedHealth
22.1%
denial rate
Modifier -25 absent on same-day procedure and E/M
Aetna
19.7%
denial rate
Bundled service billed separately (NCCI edits)
BCBS
16.2%
denial rate
Time-based E/M missing total time documentation
99214 → 99213
E/M Level Downcoding
MDM documented at moderate complexity; billed at low
Modifier -25
Same-Day Procedure Gap
Preventive visit + acute problem addressed — E/M omitted
99497
Advance Care Planning
Documented but not billed — 23 min threshold often met
Takes 2 minutes. No billing system access required.
The same EOB.
Finally readable.
What happened
You billed a 99213 (low complexity) but your documentation — 3 chronic conditions reviewed, 2 medication changes, new acute complaint — clearly supports 99214 (moderate complexity).
The modifier error
Modifier -25 was attached to 99213. UnitedHealth requires -25 only on E/M codes when a separate procedure is performed the same day. Here, no procedure was billed — the modifier triggered an automatic review and denial.
The remark codes
CO-4 = the procedure code is inconsistent with the modifier. PR-96 = non-covered charge because the patient has coverage limitations — but only for this code combination.
What to do
Refile as 99214 without modifier -25. Attach the corrected claim to payer portal within 180 days. Expected reimbursement: $168.20.
94%
of refiled claims paid on first resubmission
12 min
average time to understand a denial with Clarity
$168
recovered per corrected E/M claim on average
180 days
timely filing window — Clarity tracks every deadline
Pick up the money
off the floor.
Five data points. One exhale. The path forward is just arithmetic — and Clarity does the math.
No form on this page. No commitment. Just an audit.