What we do / Coding and charge reviewIncluded
We code every visit, and check every claim first
Your clinicians document the care. We code each visit from the signed note. Software checks every code, unit and modifier against the signed note and the insurance company's written rules. Our billing specialists review everything the software flags and make the judgment calls.
Who does what
Who does what in coding and charge review
Mohenara
- Codes every visit from your clinician's signed note.
- Checks each visit against the note and the insurance company's rules.
- For physical therapy, also checks timed units, GP, KX and plan-of-care dates.
- Sends your clinician each documentation question with the reason.
- Fixes errors that are not clinical, such as patient details and payer IDs.
Your clinicians
- See patients, document the care and sign the notes.
- Answer our documentation questions.
Charge review
Claim C-28941
Secondary plan| Code | Service | Modifiers | Minutes | Units | Charge | Allowed | Expected |
|---|---|---|---|---|---|---|---|
| 97140 | Manual therapy | GP CQ | 30 | 2 | $156.00 | $36.58 | $36.00 |
| 97530 | Therapeutic activities | GP CQ | 15 | 1 | $90.00 | $28.82 | $28.35 |
| 97112 | Neuromuscular re-education | GP CQ | 17 | 1 | $85.00 | $22.71 | $22.35 |
| Total | 62 | 4 | $331.00 | $88.11 | $86.70 |
Expected is the allowed amount less Medicare sequestration (2% of Medicare's payment, CARC 253).
Checks before the claim went out
7 of 7 passed- Passed: 62 timed minutes = 4 units under Medicare's 8-minute rule (53 to 67 minutes).Software
- Passed: GP on every line.Software
- Passed: CQ on every line: a PTA furnished the visit. Medicare pays these lines at 85%.Software
- Passed: KX not needed: $1,298.63 of therapy this year before this visit, under $2,480.Software
- Passed: Plan of care certified Jul 15 through Sep 23; this visit is covered.Software
- Passed: 97140 with 97530 on the same day: no Medicare code-pair edit since 2020, so no 59 or X modifier.Software
- Passed: Units within Medicare's daily limits (MUE).Software
What we check
What we check, both ways
A check looks for what was billed without support in the note, and for care in the note that was never billed. Each row says what we do.
| Check | What it catches | What we do |
|---|---|---|
| Billed but not supported | A code, unit or modifier on the claim that the signed note does not support. | We bill only what the note supports, and ask your clinician when it is unclear. |
| Documented but not billed | Care recorded in the signed note with no code on the claim. | We code it, so the care your clinician gave is billed. |
| Units against minutes | Timed units that do not match the minutes documented in the note. | We bill units from the minutes documented. |
| Required modifiers | A modifier the insurance company's written rules require for the service. | We add it when the note supports it. |
| Specialty rules | Rules that apply to one specialty, for example plan-of-care dates for physical therapy. | We check them on every claim, and tell your practice when a signature is needed. |
| Code-pair and unit edits | Codes that do not pay together, or units above a daily limit. | We resolve them from the note before the claim goes out. |
| Missing signatures | A note without a signature. | We hold the claim until your clinician signs. |
- We code every visit from your clinician's signed note. When a note does not support a code, we ask your clinician to clarify.
Claims go out under your National Provider Identifier (NPI)
Medicare's enrollment form says it plainly: "Even if you use a billing agency/agent, you remain responsible for the accuracy of the claims submitted on your behalf."1 So we check every claim against the note before it goes out.
- We never upcode. Software never raises a code level or adds units.
- We never ask a clinician to change a signed note to get a claim paid.
Coding and software
Why we never upcode
Insurers now look for claims that software pushed up. The Blue Cross Blue Shield Association says hospital AI coding tools added $942 million in spending over two years.2 We use software to catch what is missing or unsupported, never to push a code up.
What audits find
Where Medicare finds documentation problems
Medicare reviews a random set of paid claims against the medical record. These are audit findings, not denial rates.
- Medicare audit dataIn Medicare audits of established office visits, the top root cause was documentation that supports a lower level of visit than the one billed (120 audited claims). Improper payment rates on established office visits: family practice 2.0%, internal medicine 5.7% (claims from 2023-07-01 to 2024-06-30). An improper payment rate is not a denial rate.2.0%, 5.7%
Source: CMS, 2025-113
- Example: physical therapy. Medicare audit dataPhysical therapists in private practice: Medicare improper payment rate 19.9%, and 88.3% of those improper payments were insufficient documentation (claims from 2023-07-01 to 2024-06-30). An improper payment rate is not a denial rate.19.9%
Source: CMS, 2025-113
Questions
Questions about coding and charge review
We do not bill a code the documentation does not support. We ask your clinician to clarify, with the reason.
We never upcode, and we never ask anyone to change a signed note to get paid.
We do. Mohenara codes every visit from your clinician's documentation and owns coding accuracy. Your clinicians document care; they do not choose codes.
Every code, unit and modifier is checked against the note and the insurance company's rules before the claim goes out. We never upcode. Software never raises a code level or adds units.