Three real billing gaps Zorva caught on actual encounters from our validation set. Each entry pairs a clinical scenario with the auditor's findings, the biller's alternative workflow, and the dollar impact. Anonymized; the patient identifiers below are SHA-256 hashes.
An established patient came in for an annual wellness visit. The physician also performed and billed a separate problem-focused ECG the same day. Without modifier -25 on the E/M line, the system would treat the second service as bundled into the first and flag it. (This is a SAMP…
An established patient with hypertension returns for follow-up. The physician documents palpitations, orders an echocardiogram and a lipid panel. The biller submits an E/M claim (99214) and the lipid panel (80061), but forgets to bill the echocardiogram (93306). (This is a SAMPLE…
An established patient comes in for a problem-focused visit with palpitations. The physician performs an in-office ECG, reviews it, and orders a lipid panel. The chart supports a same-day E/M (99214) plus ECG (93000) plus lipid panel (80061). Five ground-truth findings span evalu…
An established Alberta patient (UHC 12345-6789) presents with a 2-week history of cough and shortness of breath. The family physician performs a same-day comprehensive office visit (AHCIP 03.04A), orders a chest X-ray (AHCIP X-090), and writes a referral to a respirologist. Docum…
v1 case studies. The data is real (drawn from data/val.json and data/train.json); the prose is hand-written. Future versions will add per-specialty case studies and a downloadable PDF for the one-pager.