E&M Coding Case Study: Higher Revenue Per Patient

How Lister Increased Revenue per Patient Through Smarter E&M Coding and Documentation

Client Profile

Two growing outpatient medical centers, under same owner, in the United States were looking to improve reimbursement performance without increasing patient volume.

While patient visits remained consistent, opportunities existed to improve coding accuracy, strengthen documentation practices, reduce reimbursement leakage, and maximize revenue generated from each patient encounter.

The centers partnered with Lister to manage the billing process, provide coding oversight, and create a structured feedback system that would improve both compliance and financial outcomes.

The Challenge

The centers followed a standard three-day claim submission process, with charges entered three days after the date of service.

While claims were being submitted on time, several revenue cycle challenges limited reimbursement potential:

Inconsistent E&M Level Selection

Providers were not always selecting the most appropriate Evaluation & Management (E&M) level supported by documentation.

This created two significant risks:

Under-coding, resulting in lost revenue opportunities.
Over-coding, increasing compliance and audit exposure.

Limited Visibility into Documentation Gaps

Providers often lacked structured feedback regarding coding opportunities and documentation deficiencies.

Without a systematic review process, educational opportunities were being missed.

Lister's Approach

Rather than focusing solely on claim submission, Lister implemented a proactive documentation and coding improvement strategy designed to optimize reimbursement while maintaining compliance.

Structured Pending Log Management

Lister introduced a comprehensive pending log process that categorized outstanding items by:

Provider
Insurance
Workers’ Compensation
Lab Results

This structured approach enabled the client to quickly route follow-ups to the appropriate team members and resolve issues efficiently.

Real-Time E&M Review

Every encounter underwent an additional quality review before claim submission.

When documentation supported a higher E&M level than originally selected:

Claims were updated to the documentation-supported level.
Changes were tracked in a dedicated ”E&M Level Changed Information” log.
Feedback was provided for ongoing provider education.

When documentation did not support the selected E&M level:

Claims were held for provider review.
Medical records were corrected before submission.
Compliance risks were minimized.

Continuous Provider Education

Rather than treating coding corrections as isolated events, Lister created an ongoing educational process.

Providers received regular feedback regarding:

Documentation best practices
E&M level selection
Coding accuracy
Compliance requirements

Over time, this improved both coding confidence and documentation quality across the organization.

The Results

Level 4 Billing Increased from 40–50% to 70–80%

One of the most significant outcomes was the improvement in E&M coding accuracy.

Prior to October 2025, Level 4 visits represented approximately 40–50% of encounters.

Following Lister’s documentation review and provider education initiatives:

Level 4 utilization consistently increased to 70–80%
Some months exceeded 85%
Revenue capture improved substantially without increasing patient volume

This improvement reflected better documentation, more accurate coding, and stronger provider awareness.

Denial Recovery and Appeals Management

For claims denied due to credentialing-related out-of-network status, Lister pursued aggressive appeal strategies.

The team:

Documented medical necessity
Submitted detailed payer appeals
Followed up through resolution

As a result, approximately 70% of denied claims were successfully overturned and paid.

Revenue Per Patient Grew

As coding accuracy improved, both centers experienced substantial growth in revenue generated per patient visit.

Center 1

Following implementation of documentation improvements in 2025, revenue per patient consistently exceeded their previous months, touching a new high.

Level 4 utilization increased from 44% to as high as 89%.

Center 2

Revenue per patient increased dramatically following implementation, and reached a peak in their history.

Level 4 utilization improved from 46% to as high as 90%.

Increased Reimbursement Without Increasing Patient Volume

A key achievement of this engagement was that financial performance improved without relying on additional patient visits.

Better documentation
More accurate E&M selection
Reduced under-coding
Stronger compliance controls
Successful denial recovery efforts

This enabled the centers to maximize revenue from services already being provided.

70% Success Rate on Credentialing-Related Appeals

Credentialing-related out-of-network denials represented a significant reimbursement challenge.

Through detailed appeal submissions and persistent payer follow-up, Lister successfully recovered payment on approximately 70% of denied claims.

This created an immediate positive impact on collections and cash flow.

Key Outcomes

Revenue per patient grew in both centers
Level 4 utilization increased from approximately 40–50% to 70–80%
Documentation quality improved significantly
Provider coding accuracy increased through continuous education
Reduced compliance and audit risk
70% of credentialing-related denials successfully overturned
Improved reimbursement without increasing patient volume
Stronger collaboration between providers and billing teams

Conclusion

This engagement demonstrates that meaningful revenue growth does not always require more patients—it often requires capturing the full value of the care already being delivered.

By combining documentation improvement, coding oversight, provider education, denial recovery, and proactive revenue cycle management, Lister helped these two medical centers significantly improve reimbursement performance while maintaining compliance.

The result was a stronger, more accurate revenue cycle, higher revenue per patient, and a scalable framework for long-term financial success.

Every patient encounter represents revenue your practice has already earned—but only accurate documentation and coding ensure you receive the reimbursement you’re entitled to. Lister works alongside providers to improve documentation quality, strengthen coding accuracy, and maximize compliant reimbursement without increasing patient volume. If you believe your practice may be under-coding or missing legitimate reimbursement opportunities, we’d be happy to assess your current billing performance.

Why Healthcare Providers Choose Lister?

20+ years as Trusted RCM Partner.
5 M+ claims in Urgent Care, Primary Care & Family Practice.
98% First Pass Acceptance Rate.
<5% Initial Claim Denial Rate.
<10% Over 90 Days AR.
Working with one of the largest Urgent Care Brands in the US.
HIPAA Compliant & Secure processes.

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