Billing & Coding

Every note generated by Scribeable includes AI-powered billing analysis. This helps providers and practices:

• Capture revenue that would otherwise be missed
• Document at the correct complexity level for the encounter
• Identify HCC codes for Medicare Advantage patients
• Reduce billing denials with complete documentation

Practices using Scribeable's billing features report capturing $75–150K in additional annual revenue per provider.

Scribeable analyzes the clinical content of each note and suggests relevant ICD-10 codes:

• Primary diagnosis: The main reason for the encounter, flagged as primary
• Secondary diagnoses: Comorbidities and additional conditions documented in the note
• Severity coding: Each code includes a severity indicator (mild, moderate, severe) based on the clinical context
• Chronic conditions: Conditions flagged as chronic are highlighted for annual recapture

Codes are suggestions only — always verify against your clinical judgment and payer requirements before submitting claims.

For Medicare Advantage and value-based care, Scribeable identifies Hierarchical Condition Category (HCC) coding opportunities:

• HCC code mapping: Each relevant ICD-10 code is mapped to its HCC category (e.g., HCC18 for Diabetes with Chronic Complications)
• RAF value display: The Risk Adjustment Factor weight is shown for each HCC code
• Total RAF score: Aggregate RAF score across all captured HCC codes for the encounter
• Missed opportunities: Scribeable flags HCC conditions that appear in the clinical context but aren't explicitly documented — with suggested ICD-10 codes to capture them

HCC opportunities include a confidence level (low, medium, high) and the specific clinical context that triggered the suggestion.

Scribeable evaluates your documentation against CMS guidelines to recommend the appropriate Evaluation & Management level:

• MDM analysis: Problem complexity, data complexity, and risk level are each scored (minimal, low, moderate, high)
• Conservative vs. supported CPT: Two recommendations — a conservative code and the highest supportable code based on documentation
• Work RVU estimate: Estimated RVU value for the recommended code
• Reimbursement estimate: Approximate dollar value based on current Medicare rates

CMS 2024–2026 Features

• G2211 add-on code: Scribeable flags when G2211 (complex E&M add-on) is applicable with eligibility reasons
• Time-based billing: If you document time spent, Scribeable tracks total minutes and recommends the appropriate time-based code
• Two-Midnight Rule: For inpatient encounters, justification fields for admission documentation

Scribeable automatically runs relevant clinical calculators based on your specialty and the encounter content. Calculators are only included when clinically appropriate:

Calculators are filtered by your specialty setting — a cardiologist sees CHA2DS2-VASc and NYHA, while a pulmonologist sees CURB-65. Over 30 calculators are available across all specialties.

Each note includes quality indicators that help ensure billing-ready documentation:

• Completeness score: Are all required sections documented?
• Clarity score: Is the documentation specific enough for coding?
• Sepsis documentation: Flagged when sepsis criteria are present
• Respiratory failure: Flagged when documentation supports respiratory failure coding
• Malnutrition screening: Flagged for appropriate encounters
• MCC/CC counts: Major comorbid conditions and comorbid conditions tallied for DRG impact

After generating a note:

1. Review the Billing section at the bottom of your generated note
2. Check suggested ICD-10 codes against the clinical content
3. Review any HCC opportunities flagged — add documentation for conditions you treated but didn't explicitly capture
4. Verify the E&M level matches the complexity of your encounter
5. Export the complete note with billing codes to your EHR

Billing suggestions are AI-generated and should be reviewed by the provider. Always verify codes against clinical documentation and payer guidelines.