Name: EarnedMD
Brand: EarnedMD

Question 1

Does EarnedMD Work for Physical Therapy Practices?

Accepted Answer

Physical therapy support is in early access for private outpatient practices. It reviews daily notes, evaluations and re-evaluations against the CPT codes and units billed. PT practices get a therapy-specific review instead of the medical E/M and ICD-10 review. It reads the interventions and treatment minutes in each note and compares them with what was billed. Early access is focused on private outpatient practices. Hospital outpatient and home health settings follow different billing rules and are not fully supported yet.

Question 2

How Does EarnedMD Apply the 8-Minute Rule?

Accepted Answer

Timed units are calculated by fixed rules from the minutes in your note, not estimated by AI, so the same documentation always gives the same result. AI is used only to read the note and pull out each intervention and its documented minutes. The unit calculation itself follows the CMS 8-minute rule: total timed minutes set the total units (for example, 38 to 52 minutes supports 3 units), and units are then assigned to services by their documented time. Each finding shows the minutes used and the calculation, so your team can check it. Commercial and other payers may count units differently, so those findings are marked for payer-rule confirmation.

Question 3

What Does a Therapy Documentation Review Look For?

Accepted Answer

Common findings include under-billed or over-billed timed units, billed services with no documented time, and notes missing skilled-care justification. Supported opportunities include documented timed minutes that support more units than were billed. Compliance risks flag units that exceed the documented minutes, or billed services that do not appear in the note. Documentation opportunities highlight gaps payers often look for, such as missing skilled-care justification, progress toward goals, or a missing re-evaluation when the plan of care changes.

Question 4

Why Don't Therapy Reviews Show Dollar Amounts?

Accepted Answer

Therapy payment depends on your payer mix, fee schedules and payment adjustments, so EarnedMD shows the unit and coding finding and leaves the dollar impact to your fee schedule. Findings show the code, the units and the documented minutes behind them, and note that financial impact requires fee schedule or payer verification.

Question 5

Does EarnedMD Work for Dental Practices?

Accepted Answer

Yes. Dental practices get a dedicated review that checks clinical notes against CDT coding, using dental terminology throughout the app. When you set up your practice as Dental, EarnedMD uses a dental-specific analysis instead of the medical E/M and ICD-10 review. It reads restorative, periodontal, surgical, and preventive notes and compares what was documented with the CDT codes billed. Your dashboard, audits, and reports use dental wording, such as encounters reviewed and dental coding opportunities, so the results match how your team works.

Question 6

What Does a Dental Documentation Review Look For?

Accepted Answer

Common findings include missed procedures, surface counts that don't match the note, incomplete periodontal charting, and codes the note doesn't fully support. Typical supported opportunities include a documented exam or procedure that was not billed, or a restoration billed as one surface when the note describes two or more. Documentation opportunities highlight missing details payers often expect, such as tooth numbers, surfaces, pocket depths, or medical necessity for scaling and root planing. Compliance risks flag cases where the billed CDT code may not be supported, such as a surgical extraction billed without documentation of the surgical approach.

Question 7

Why Don't Dental Reviews Show Dollar Amounts?

Accepted Answer

Dental fees vary widely by fee schedule and payer contract, so EarnedMD shows the coding finding and leaves the financial impact to your fee schedule. Medical reimbursement follows widely published rates, but dental fees depend heavily on each practice's fee schedule, PPO contracts, and plan limits such as frequencies and annual maximums. To avoid misleading estimates, dental findings show the code change and supporting evidence, and note that financial impact requires fee schedule or payer verification.

Question 8

What Is Underbilling?

Accepted Answer

Underbilling happens when a claim is submitted for a lower-level service than what the clinical documentation actually supports — leaving earned revenue on the table. Underbilling occurs when a provider documents a clinical encounter that supports a higher level of service (such as a Level 4 office visit) but the claim is submitted at a lower level (such as a Level 2 or 3). This is often unintentional — driven by fear of audits, time pressure, or uncertainty about documentation requirements. The result is significant, compounding revenue loss. A practice seeing 1,500 encounters per month that consistently underbills by just one E/M level could be leaving tens of thousands of dollars on the table annually — revenue that is already earned through the work performed and documented. Importantly, billing for the level of service your documentation supports is not upcoding — it's accurate billing. Underbilling is not a compliance safeguard; it's a revenue leak that most practices never detect because the claims are paid without issue. EarnedMD reviews your de-identified clinical documentation and flags encounters where the documented work supports a higher level of service than what was billed, giving you the evidence to capture that revenue going forward.

Question 9

Can a Paid Claim Still Represent Missed Revenue?

Accepted Answer

Yes — a paid claim confirms the codes were accepted, not that they captured everything the documentation supports. A claim being paid simply means the payer accepted the codes that were submitted. It does not confirm that those codes captured everything the clinical documentation supports. Undercoded and incompletely coded claims are paid without issue, so they never surface in denial reports. This is why standard billing metrics — denial rate, clean claim rate, days in A/R — can all look healthy while revenue is still being left behind. The gap lives between what was billed and what the clinical record actually supports. EarnedMD closes that visibility gap by analyzing the documentation itself, not just the billed codes, to surface opportunities that a paid claim would otherwise hide.

Question 10

The True Cost of Undercoding

Accepted Answer

Undercoding is one of the largest hidden revenue leaks in medical practices — and most never know it's happening. Studies estimate that undercoding affects a significant percentage of encounters in many practices. Unlike claim denials or rejections, undercoded claims are paid — so they never trigger an alert. The revenue simply never arrives. Consider a mid-sized practice with 3 providers and 1,200 monthly encounters. If 15% of encounters are undercoded by an average of $40 per encounter, that's $7,200 per month — over $86,000 per year in earned but uncollected revenue. The challenge is that undercoding is invisible in standard billing reports. Your denial rate looks great. Your clean claim rate is high. But the practice is systematically undercharging for the work being done. EarnedMD makes undercoding visible. By analyzing the clinical documentation itself — not just the billed codes — we surface encounters where the documented complexity, medical decision-making, or time supports additional or higher-value codes.

Question 11

Documentation That Supports Higher E/M Levels

Accepted Answer

Understanding what your documentation needs to say to support the E/M level your work actually warrants. Since the 2021 E/M guideline changes, office visit code selection is based on either Medical Decision Making (MDM) or total time spent on the date of the encounter. Many providers don't realize their documentation already supports a higher level than they're billing. MDM has three elements: the number and complexity of problems addressed, the amount and complexity of data reviewed, and the risk of complications or morbidity from management. Meeting two of three elements at a higher level qualifies for that E/M level. Common documentation patterns that support higher levels include: documenting review of external records, noting independent interpretation of tests, documenting discussion of management with another provider, and clearly stating the risk of the condition if untreated. EarnedMD analyzes your encounter notes for these documentation patterns and identifies where the MDM or time documented supports a higher E/M level than what was billed — with specific supporting evidence cited from the note itself.

Question 12

Incident-To Billing for NPs and PAs

Accepted Answer

When non-physician providers can bill at 100% of the physician rate — and when they can't. Incident-to billing allows services provided by a Nurse Practitioner (NP) or Physician Assistant (PA) to be billed under a supervising physician's NPI at 100% of the Medicare physician fee schedule — rather than the standard 85% rate for non-physician providers. To qualify, several conditions must be met: the service must be one that the supervising physician would typically personally perform, the physician must have a treatment plan in place for the patient's condition, the physician must be physically present in the office suite and available to provide assistance, and the service must be furnished in the physician's office (not a facility setting). When these conditions aren't met, the NP or PA service must be billed at 85% of the physician rate. Many practices miss this distinction, leaving 15% of their NP/PA revenue uncollected when incident-to requirements are actually met. EarnedMD flags encounters where the documentation suggests incident-to billing may be appropriate, helping practices ensure they're capturing the full reimbursement their documentation supports.

Question 13

Common Missed Revenue Opportunities

Accepted Answer

Beyond E/M levels, many practices miss add-on codes, modifiers, and diagnosis specificity that their documentation already supports. Missed revenue isn't just about undercoding E/M levels. Many encounters support additional codes that are never billed — including add-on codes for prolonged services, modifier 25 for significant separately identifiable E/M services, and chronic care management codes. Diagnosis specificity is another common gap. ICD-10 requires coding to the highest level of specificity, but many encounters are documented with less specific codes than the note supports — such as coding 'diabetes' when the note specifies 'type 2 diabetes with diabetic neuropathy.' Preventive medicine services are frequently missed when a wellness visit and a problem-focused visit occur on the same day. Modifier 25 allows both to be billed, but many practices only bill the wellness visit. EarnedMD scans for all of these opportunity types — missed add-on codes, modifier opportunities, diagnosis specificity gaps, and documentation that supports additional services — so you can see the full picture of what your documentation earns.

Question 14

What Is Practice Revenue Optimization?

Accepted Answer

Ensuring the practice captures all of the revenue its clinical work and documentation legitimately support — not just what happens to be billed. Practice revenue optimization is the discipline of ensuring the practice captures all of the revenue its clinical work and documentation legitimately support — not just the subset that happens to be billed correctly. It spans documentation quality, coding accuracy, revenue capture, revenue integrity, performance analytics, and continuous optimization. Each capability reinforces the others: better documentation enables accurate coding, accurate coding enables complete revenue capture, and analytics turns that into ongoing improvement. Unlike denial management, which reacts to claims that fail, revenue optimization proactively examines claims that succeed to find what they may have missed.

Question 15

Revenue Integrity vs. Upcoding

Accepted Answer

Billing accurately for what your documentation supports is not upcoding — it's the standard of care for your practice's financial health. There's an important distinction between revenue integrity and upcoding. Upcoding is billing for a higher level of service than the documentation supports — that's fraud. Revenue integrity is billing for exactly what the documentation supports — that's accurate billing. Many practices err on the side of underbilling out of fear of audits. But systematically underbilling is not a compliance strategy — it's a business decision that costs the practice earned revenue. The compliant approach is to bill accurately, supported by documentation. EarnedMD only flags opportunities that are directly supported by your existing clinical documentation. Every finding includes the specific evidence from the encounter note that supports the recommended code — so you can verify the basis before acting. Our findings are decision-support recommendations, not final coding determinations. Your coding team reviews each opportunity and decides whether to act on it, ensuring you maintain full control over your billing decisions.

Question 16

Can AI Identify Potential Undercoding?

Accepted Answer

Yes — AI reviews encounter notes and compares what the documentation supports against what was billed. AI can review clinical encounter notes and compare what the documentation supports against what was billed — flagging encounters where the documented complexity, medical decision-making, or time suggests a higher or additional code. AI is most effective as decision support: it surfaces candidate opportunities with supporting evidence and a confidence score, which a trained coder then validates before any change is made. It does not replace clinical judgment or coding expertise. EarnedMD applies this approach at scale, reviewing encounters consistently and surfacing patterns across providers that manual sampling would miss.

Question 17

How EarnedMD Works

Accepted Answer

A simple, secure process to turn your existing clinical documentation into recovered revenue. EarnedMD analyzes your de-identified clinical encounter notes and compares what the documentation supports against what was billed. The process is designed to be simple and secure from start to finish. Step 1: Upload de-identified encounter files — PDFs, text files, or photos of chart notes. As a safety net, EarnedMD automatically scrubs any ePHI it detects before analysis. Step 2: Our analysis engine reviews each encounter for revenue opportunities — undercoded E/M levels, missed add-on codes, modifier opportunities, diagnosis specificity gaps, and documentation that supports additional services. Step 3: Review your findings. Each opportunity includes the specific supporting evidence from the note, an estimated revenue impact, and a confidence score. Your team reviews and decides which to act on. Step 4: Track your recovered revenue over time through the dashboard and reports, giving you ongoing visibility into your practice's revenue integrity.

Question 18

How to Download PT Daily Notes from Your Documentation Software

Accepted Answer

Step-by-step guides for exporting a single visit's daily note as a PDF from widely used physical therapy EMRs. EarnedMD reviews one therapy visit at a time: the daily note (or evaluation/re-evaluation) for that date of service. You don't need the full plan of care or patient ledger. For the most accurate timed-unit review, make sure the note includes each intervention with its minutes, total timed minutes, and total treatment time. After uploading, you can also enter the payer, appointment minutes, and billed CPT codes and units. If your software isn't listed, open the signed note, choose Print, and select 'Save as PDF'. You can also copy the note text and use the Paste Text option on the upload screen.

Question 19

How to Download Dental Chart Notes from Your Practice Software

Accepted Answer

Step-by-step guides for exporting clinical notes for a single appointment as PDFs from widely used dental practice management systems. EarnedMD reviews one dental visit at a time: the clinical note for that appointment plus the procedures completed. You don't need the full patient chart or ledger. Including the procedures posted for the visit (CDT codes with tooth numbers and surfaces) gives the most accurate review. Most systems let you print the clinical note and the progress notes or procedure history for a date range. If your software isn't listed, look for a Print or Preview option on the clinical note and choose 'Save as PDF'. You can also copy the note text and use the Paste Text option on the upload screen.

Question 20

How to Download Patient Encounters from Your EHR

Accepted Answer

Step-by-step guides for exporting encounter notes as PDFs from six widely used EHR systems, so you can upload them to EarnedMD for analysis. EarnedMD analyzes individual patient encounters — a single visit's clinical note — not the entire patient chart. When exporting from your EHR, select the specific encounter you want analyzed rather than exporting the whole chart. The general process is the same across systems: open the patient encounter, find the clinical note, and export or print it to a PDF file. Then de-identify the PDF before uploading. Below are specific steps for six widely used EHR systems. If your EHR isn't listed, the same approach works: look for a Print, Export, or Download option on the encounter note and choose 'Save as PDF.'

Explore Practice Revenue Optimization

Understanding Revenue Leakage