Clinical Documentation Improvement Advisor

Key facts

• Price: $29/mo
• Category: business
• Environment: ironclaw
• Tags: medical coding, ICD-10, clinical documentation, HCC, risk adjustment, CDI
• Seller: ClawHQ

What it does

For small medical practices (1-10 providers) losing an estimated $125K/year to coding deficiencies — without budget for an $80K/year CDI specialist. This agent proactively reviews clinical documentation before claim submission to upgrade unspecified ICD-10 codes to their most specific valid alternatives, capture missing HCC (Hierarchical Condition Category) codes for Medicare Advantage panels, and identify documentation gaps that trigger claim downcoding or denial. ## What's included - **Pre-submission documentation review** — paste a SOAP note or encounter summary, get coding opportunities flagged: E11.9 (diabetes unspecified) becomes E11.65 (type 2 DM with hyperglycemia) when A1C + clinical indicators support it - **Documentation language suggestions** — exactly what to add to the note to make the code bulletproof on audit; never compromises clinical accuracy, only specificity - **HCC review for Medicare Advantage panels** — maps patient condition list to HCC categories, estimates RAF impact of missing codes, generates physician query templates for each gap - **AHIMA-compliant physician queries** — both multiple-choice and open-ended formats; auto-generated for any documentation gap; queries tracked in memory with weekly cron follow-up for outstanding queries older than 5 business days - **Coding audit mode** — benchmarks your practice against CMS + specialty-norm data; calculates estimated annual revenue leakage with transparent methodology - **90-day improvement plan** — prioritized action items: which providers, which code families, which documentation patterns to address first - **Monthly CDI progress reports** — specificity rate trend, HCC capture rate trend, query response rate, estimated revenue captured month-over-month - **Specialty coverage** — primary care, internal medicine, cardiology, endocrinology, nephrology, orthopedics, psychiatry; specialty-specific code families + documentation patterns - **MIPS quality measure flagging** — surfaces encounters that could close MIPS quality measure gaps with the right documentation ## Limitations - **Not a medical coder** — supports coders + providers with specificity + HCC review; final code assignment + claim submission stays with certified coders / billers - **Not an EHR** — paste notes from Epic / Athena / eClinicalWorks / Practice Fusion / Kareo; doesn't integrate directly with EHRs - **Not a billing service** — pairs with your existing billing service (in-house or outsourced); this is the upstream CDI layer - **Not legal counsel** — coding compliance, RAC audits, OIG investigations need a healthcare attorney - **Not a payer-specific appeals tool** — pairs with Insurance Claim Denial Manager (separate listing) for reactive appeals after denial - **U.S.-ICD-10-CM-focused** — ICD-10-CM + HCC are U.S.-Medicare-anchored; international coding (ICD-10-CA, ICD-10-AM) adapts ## Best fit Small primary care, internal medicine, and specialty practices with 1-10 providers — too small to justify an $80K CDI specialist but bleeding revenue to unspecified coding. Especially valuable for practices with significant Medicare Advantage panels where HCC capture directly drives capitation revenue. At 1-2% revenue lift on a $2M practice, that's $20K-$40K/year recovered — and the subscription is $99/mo.