Undocumented time and missed HCCs cost geriatrics practices recoverable revenue every day.
Geriatrics revenue runs on cognitive and care-management work, chronic care management, transitional care, annual wellness visits, and risk-adjustment coding, where the work is done but the documentation and codes don't capture it. Manual billing teams catch a fraction of the gaps. Ember catches all of them.
Trusted by specialty groups and health systems
Where geriatrics revenue leaks
The revenue-capture gaps Ember was built for
Geriatrics revenue leaks through cognitive and care-management work, not procedures. Chronic care management, transitional care, annual wellness visits, and risk-adjustment coding are performed every day but under-documented and under-coded. Ember closes each gap.
01 · Chronic care & transitional care management
CCM, complex CCM, and TCM undercoded or time not documented to the level billed.
Chronic care management and transitional care management are time-based services, and when care-plan minutes and post-discharge activities aren't captured in the note, complex CCM collapses to basic CCM or TCM goes unbilled entirely. The work is done; the documentation doesn't support the level. Ember validates logged time against each code's threshold before submission.
99490 · 99439 · 99487 · 99495 · 9949602 · Annual wellness visits & risk adjustment
AWV and HCC capture gaps where risk scores understate patient acuity.
Annual wellness visits and advance care planning are frequently missed or undercoded, and chronic conditions that drive risk adjustment go uncaptured when MEAT and MCC documentation is absent. Understated HCCs mean the risk score doesn't reflect the panel's true acuity. Ember surfaces the missing HCC and MEAT link before the encounter closes.
G0438 · G0439 · 99497 · HCC03 · E/M level & prolonged services
MDM-based leveling and prolonged services down-coded against the documentation.
Complex elderly patients carry high medical decision-making, yet visits are routinely down-coded and prolonged and advance-care-planning services go unbilled. The note supports a higher level than the claim reflects. Ember re-levels every encounter against MDM and documented time, and builds the case when a payer down-codes.
99214 · 99215 · G2212 · 99417Three engines.
One source of truth.
Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer. Built for the time-based, documentation-driven, risk-adjusted nature of geriatric care management.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every encounter and provider.
E. Whitfield
Encounter #G-45092
02 · Audit
Coding Engine
Reviews 100% of encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.
Recode 99487 — complex CCM, 62 min care-plan time
CMS CCM policy · confidence 0.96
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the applicable LCD/NCD policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #G-45092 · Down-code 99214 → 99213
Documented MDM supports 99215: three chronic conditions with exacerbation and high-risk medication management, per 2021 E/M guidelines…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for geriatrics practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the undercoded care-management time before the claim leaves.
Ember reviews every encounter against coding standards, payer care-management policy, and your contracts. Time-threshold gaps, missing HCC and MEAT links, and MDM-based leveling issues are flagged before submission.
- 1
Ingest the encounter
Pulls visit notes, care-plan time logs, transitional-care records, and problem lists from your EHR and practice management system.
- 2
Validate against rules
Checks CCM and TCM time thresholds, MDM-based E/M leveling, HCC and MEAT documentation, and AWV eligibility against each payer's specific policies.
- 3
Recommend with citation
Returns the suggested correction tied to the exact CMS care-management policy, risk-adjustment rule, or contract term.
- 4
Educate the provider
Documentation patterns drive provider-level coaching, so time logging, MEAT capture, and MDM detail improve across every clinician.
Recode 99487 + re-level 99215 — time and MDM support both
CMS CCM & E/M policy · confidence 0.97
+23%
Clean-claim rate
100%
Encounters reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial or down-code occurs, Ember identifies the root cause, retrieves visit notes, care-plan time logs, and problem-list documentation, references payer policy and contract terms, drafts the appeal, and tracks it through adjudication.
Medical necessity
Missing documentation
E/M down-code review
CCM medical necessity
99215 re-level appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per appt
The full revenue cycle
From eligibility to adjudication. Covered.
Audit and appeals are the workhorses, but Ember protects geriatrics revenue at every stage of the cycle.
Eligibility Verification
Confirms active coverage and Medicare and Medicare Advantage benefit structure before the visit, and flags care-management and AWV eligibility gaps before they become billing problems.
Prior Authorization
Checks auth requirements in real time for advanced imaging, DME, and home health, generates medical-necessity documentation, and submits to payer portals automatically.
AI Medical Coding
Reviews 100% of encounters, time-based E/M, CCM and TCM, and HCC risk adjustment, against national standards and payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching undercoded care-management time, missing HCC and MEAT documentation, and MDM-based leveling gaps before they generate write-offs.
Denial Management
Full appeal lifecycle for every geriatrics denial type, medical-necessity appeals for care-management services, E/M down-codes, and documentation denials, tracked to adjudication.
Underpayment Recovery
Parses contracts to model what each care-management, wellness, and E/M claim should pay, then surfaces line-item underpayments and understated risk-adjustment revenue at scale.
Care-management revenue, captured
-57%
denial rate
+18%
documented care-management revenue
100%
encounters audited
3 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
See what your geriatrics practice is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.