EM Downcoding Webinar

Two ways to use this session

Attend live, or let it come to you.

Both options use the same form. Pick the one that fits your week.

Option 1

Attend live

Best if you want your own scenario answered.

Full 60 minute session with worked chart examples
Live question time with a certified coder and a physician
Calendar invite and reminders so it does not slip
Recording and all materials afterward as well

Option 2

Get the recording

Best if your clinic day does not stop at 4:00.

Full session recording, sent the next morning
Presentation slides you can share with your team
The documentation checklist and appeal template
A written summary of the questions we answered

Send me the recording →

What you will learn

Four things you can use on Thursday morning.

Every segment ends with something your team can apply to the next note, not a slide to file away.

Document the level you earned

The language that shows the medical decision making you already did, so the note reads at its real complexity.

Spot the drop in your own data

Where to look in your level distribution to see whether a payer is quietly shaving your codes.

Defend the level under review

The five point P.R.O.V.E. check that tells you in seconds whether a note will survive a payer audit.

Win the money back

What payers actually reverse on, and how to package an appeal so it is worth your staff's time.

A practice team reviewing coding data together

60 min

Teaching, worked charts and live questions, then everything in writing

What makes this hour different

Not a slide deck read out loud.

We score real notes on screen, the way a payer reviewer would, and rewrite them live until the level holds.

Charts worked in front of you, not summarized
The exact phrases that carry the level
Where documentation time is being wasted

Built for the note you write on Thursday, not for a folder you never open again.

The 90-Second MDM Note Builder, one page
EHR SmartPhrase pack you can install the same week
Annotated casebook of everyday encounters
Recording and slides, sent to every registrant

Bring a note you are unsure about. A certified coder and a physician answer it on the call.

Ten minutes of live questions
Written follow up on anything we do not reach
A summary of every question, sent to all registrants

The framework

P.R.O.V.E.

Five things a note has to show for an E/M level to hold. We walk each one with real chart language, then run the same five against a reduced claim to build the appeal.

Problem

The problem addressed, described at its real complexity rather than at its diagnosis code.

Risk

The risk of the management options considered, including the ones you decided against.

Orders and data

What was ordered, reviewed and interpreted, shown as analysis instead of as a list.

Verify

A fast self audit of the note against the level, before the encounter closes.

Evidence

The specific excerpts that turn a note into an appeal a payer has to answer.

A preview of the session

Same visit. Two notes. One level apart.

This is the kind of side by side we work through live, using charts that look like yours.

As commonly documented

Patient with diabetes and hypertension, both stable. Reviewed labs. Continue current medications. Follow up 3 months.

Reads as 99213

Nothing here is untrue. It simply does not show the thinking, so a reviewer scores what is on the page.

As defensible

Two chronic conditions with progression risk: A1c up 0.6 since last visit, home readings trending high. Reviewed and interpreted CMP and lipid panel against prior. Considered adding a second agent, deferred given renal function. Continue current regimen, recheck 3 months.

Supports 99214

Same visit, same clinical decision, roughly 20 extra seconds of typing. That is the whole gap.

Illustrative example. In the session we work through specialty specific charts and score each one live.

Why this matters now

A level drop is the leak nobody works.

Denials get attention because they are loud. A reduced level pays, clears and disappears into the ledger.

$40

Roughly what separates a 99213 from a 99214 on a typical fee schedule. It is small enough to ignore once and large enough to matter every day.

Denials generated by a downcode. Nothing lands in your worklist, so nothing gets worked, and the variance never reaches the owner.

Number of sentences that usually separates a defensible note from an indefensible one. That sentence is what this hour is about.

The compliance edge cuts both ways

Under-documenting a level you performed is a revenue problem. Documenting a level you did not is an audit problem. The same discipline solves both.

The loss compounds quietly

Downcoding does not spike. It settles in, and by the time it shows up in a monthly comparison you have already absorbed two quarters of it.

Most reductions go unappealed

Not because practices agree with them, but because nobody is sure what evidence would change the outcome. We show you exactly what does.

The hour

What we cover, in order.

Roughly 50 minutes of teaching and 10 minutes of live questions.

4:00 to 4:10

E/M fundamentals, refreshed

The scoring rules as they stand now, and the three places practices still lose levels out of habit.

4:10 to 4:35

P.R.O.V.E. applied to real notes

Charts worked live, with the language that moves a note from indefensible to defensible.

4:35 to 4:50

Building the appeal

What to include, what to leave out, and how to decide which reductions are worth appealing at all.

4:50 to 5:00

Live questions

Bring a scenario. We answer as many as the hour allows and follow up by email on the rest.

Who is presenting

Taught by people who work these notes.

Stephanie Hilliard

Certified Professional Coder, session lead

CPCE/M and documentation

Stephanie works E/M documentation and level integrity day to day. She translates the guidelines into language a clinician can actually type at the end of a visit, and she built the P.R.O.V.E. framework this session is organized around.

Heather Signorelli, DO

Co-Founder and Physician Advisor, NatRevMD

DOPhysician-led RCM

Dr. Signorelli hosts and takes questions. She brings the physician side of the trade off between documentation time and defensible revenue, and the operator side of what a practice can realistically change without slowing the schedule.

Practice leaders reviewing reimbursement reports

Who should attend

Built for independent, physician-owned practices.

If you own the practice or you own the revenue inside it, this hour is for you.

Physician owners and partners

Practice managers

Medical billers

Office administrators

Revenue cycle teams

Coders and documentation specialists

What you receive

A toolkit you can use in your next clinic session.

The 90-Second MDM Note BuilderOne page. A plain-language structure for documenting what you managed, what informed the decision, what you decided and what happens next
"Is This Really a Level 4?" Annotated CasebookEveryday outpatient encounters shown three ways: a thin note, a defensible note, and what would not support the higher level
EHR SmartPhrase Starter PackPrompt-driven macros you can build into Epic, Cerner or your own system the same week, written to require your specifics rather than canned text
MDM or Time? The Two-Route Decision CardA single screen on choosing the better-supported route, and exactly what a time statement has to make clear
Make the Work Visible: the Hidden Work ReferenceCognitive work you already do but rarely describe, paired with short prompts that make it visible without lengthening the note
Recording, slides and question summarySent to every registrant the morning after, including the questions we run out of time for

Register even if the time does not work.

The toolkit is not a consolation prize for missing the session. It goes to every registrant, live or not, the next morning. The only thing you give up by missing the hour is asking your own question out loud.

Plus a Practice Implementation Bonus Pack for whoever handles your billing: an appeal template, a decision tree for when a reduction is worth the staff time, and a tracking sheet for spotting reduced levels on remits.

The series so far

Over 60 practices registered for our last coding session.

This is session one of a monthly series built for independent, physician-owned practices. Every session is free, and every registrant keeps the materials.

60+

People registered for our July coding webinar, from independent practices across the country.

CPC + DO

Taught by a certified professional coder alongside a practicing physician, not by a sales team.

Monthly

A new coding session on the last Wednesday of every month, with the recording and toolkit sent to all registrants.

Before you register

Questions we get.

Is it free? +

Yes. The session is free and open to any practice that wants to attend. There is no upsell at the end.

What if I miss it? +

You still get everything. The recording, slides and resources go to every registrant the morning after the session, whether or not you attended.

How long is it? +

60 minutes. Roughly 50 minutes of teaching and 10 minutes of live questions.

Can I ask questions? +

Yes. Bring a scenario. We answer as many as the hour allows and follow up by email on the ones we do not reach.

Can I bring my team? +

Please do. Have each person register with their own email so everyone receives the join link and the materials.

Is this a sales presentation? +

No. It is a coding education session. If you want to talk about your revenue cycle afterward we are glad to, but nobody will chase you for it.

Who is it for? +

Independent, physician-owned practices and the people who run their revenue: owners, practice managers, billers, coders and revenue cycle teams.

Is this part of a series? +

Yes. This is the first session of our monthly coding series, held the last Wednesday of every month. September covers OB/GYN coding and October covers Medicare annual visits.

The series

One hour, the last Wednesday of every month.

Registering for August puts you on the list for the rest. You can leave it at any time.

August 26

E/M coding and downcoding defense

Registering now

September

OB/GYN coding and the 2027 global code split

Date follows the standing slot

October

Medicare annual visits

Date follows the standing slot

November

The October ICD changes

Planned

December

Chronic care management and urgent care