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The Level 3 vs Level 4 E&M coding gap is one of the most consistent — and least visible — sources of revenue loss in ambulatory care. A provider who appropriately qualifies for Level 4 (CPT 99214) but consistently documents Level 3 (CPT 99213) misses roughly $35–$55 per encounter. At 20 encounters per day, five days a week, that compounds to $150,000+ per provider annually.

Vizier maps every provider's E&M code distribution against their acuity data, problem list complexity, and documentation patterns. You see exactly where the gap is, which providers are most affected, and what the annualized revenue impact looks like — not as an estimate, but calculated from your actual claims volume.

This is not upcoding. It is accurate coding. The distinction matters for compliance, and Vizier surfaces only encounters where documented complexity supports a higher code under 2023 AMA E&M guidelines.

The average hospital denial rate sits between 5% and 15% of submitted claims. For a $200M revenue organization, a 10% denial rate means $20M in claims requiring rework — and an unknown portion of that will never be collected. Industry data suggests 65% of denied claims are never resubmitted.

Vizier categorizes every denial by root cause: prior authorization failure, medical necessity, duplicate claim, eligibility mismatch, timely filing, and coding error. You see denial rates by payer, by provider, by service line, and by month — with trend lines that separate seasonal variation from structural problems.

Days in AR is tracked against the 35–45 day commercial benchmark and the 14-day Medicare benchmark. When a payer's payment timeline drifts, you see it before it becomes a cash flow problem. Payer contract performance comparison shows which contracts are underperforming their negotiated rates and by how much.

The Hospital Value-Based Purchasing (VBP) program adjusts every Medicare payment by up to ±2%. For a hospital receiving $100M in Medicare payments annually, that is a $4M swing between maximum bonus and maximum penalty. The calculation depends on four domains: clinical outcomes (25%), person and community engagement (25%), safety (25%), and efficiency and cost reduction (25%).

CMS readmission penalties under HRRP have averaged $217K per hospital annually. The penalty is calculated based on excess readmission ratios for AMI, heart failure, pneumonia, COPD, hip/knee arthroplasty, and CABG. Hospitals in the bottom performance quartile face the full 3% Medicare payment reduction.

Vizier builds a financial model that projects your VBP adjustment before CMS calculates it. You see which domain scores need improvement to cross into bonus territory, what each percentage point of improvement is worth in dollar terms, and whether readmission reduction investments generate positive ROI against penalty exposure. The model updates as your performance data changes.

Payer mix directly determines revenue per encounter. A shift from 40% Medicare/Medicaid to 50% commercial can increase revenue per visit by 30–40% without any change in patient volume. Vizier tracks payer mix by provider, location, and service line — and models the revenue impact of payer mix shifts over time.

Billing code optimization goes beyond E&M levels. Vizier identifies missed procedure codes, under-utilized modifier usage, and gaps in chronic care management billing (CPT 99490 — $62/month per enrolled patient) and principal care management (CPT 99424 — $89/month). For a 500-patient chronic disease panel, CCM alone represents $372,000 in annual revenue opportunity.