Is Our Practice Undercoding Because Untrained Staff Are Picking Codes, and How Much Is It Costing Us?

What Actually Finds and Stops Systematic Undercoding

The goal is simple: every visit coded to the level the documentation supports, and the ones already underbilled recovered while they still can be. Here is what does that, move by move.

1. Audit Coded Visits Against the Documentation to Measure the Rate

You cannot fix a leak you have not measured. Pull a sample of recently coded encounters and have a certified coder recode them blind from the documentation, then compare. The gap between what was billed and what the notes support is your undercoding rate, expressed in levels and dollars. This is the only way to turn a suspicion into a number, and the number is almost always higher than the practice expects, because untrained coding fails in one direction: down. Once you can measure it, you can decide what it is worth to fix.

2. Put Certified Code Selection Back on the Encounters

The root cause is people coding outside their training, so the fix is to put trained code selection back on the work. That does not always mean rehiring in-house; it means a certified coder owns the level and the billable add-ons for each encounter, reading the documentation and coding to what it supports rather than to what feels safe. When the person choosing the code knows the guidelines, the visit gets coded for what it was, and the systematic downward drift stops at the source instead of being caught later in an audit.

3. Recode and Rebill the Recent Visits Still Inside Their Window

The undercoded claims that already went out are not all lost. For visits still inside their payer’s timely-filing window, a corrected claim at the supported level can recover the difference. A certified coder reviews the recent underbilled encounters, confirms the documentation supports the higher level, and rebills, working the ones closest to their filing deadline first. This is real recovered revenue on work already done, and the only thing standing between you and it is the filing clock, so the recovery has to move deadline-first.

4. Hold Ongoing Accuracy So the Leak Does Not Return

A one-time cleanup does not hold if code selection goes back to guesswork next month. Ongoing accuracy means certified selection stays on the encounters, a periodic audit sample keeps measuring the rate so drift is caught early, and documentation gaps that force conservative coding get flagged back to the provider. Coders self-downcode when the note looks ambiguous, so tightening documentation is part of holding accuracy, not a separate project. That is what keeps the leak closed instead of reopening the moment attention moves on.

5. Hand Code Selection to a Dedicated Team

Practices that stop the quiet undercoding do it by handing code selection to a dedicated team: certified remote coders who audit the rate, own the level and add-ons on every encounter, recover the recent underbilled visits, and hold accuracy over time, live in 1 to 2 weeks. Your staff go back to the jobs they were trained for, code selection sits with people who know the guidelines, and a trained backup covers every gap. Below is what it sounds like when coding is nobody’s trained job yet, in practice teams’ own words.

Why This Keeps Happening

If nobody chose to undercode, why does it happen so reliably? Because coding outside your training fails in one predictable direction. When a coder vacancy gets filled by task-sharing, the untrained staff are not incompetent; they are cautious, and caution in coding means down. A lower level is safer than a higher one, and skipping an add-on you are unsure about is safer than claiming it. CMS has repeatedly stressed that undercoding is as problematic as overcoding, because it undervalues patient complexity and distorts the record, and coders self-downcode whenever documentation looks ambiguous. The result is a systematic downward drift that nobody intended and nobody sees.

The reason it stays hidden is that undercoding never announces itself. An overcoded claim risks a denial or an audit; an undercoded claim pays clean and looks perfect on every report you run. There is no dashboard that says a visit was worth more than you billed, because the claim was valid, just low. The only way to see it is to recode a sample against the documentation and measure the gap. Specialty practices under staffing strain are especially exposed, because higher-acuity visits and billable add-ons are exactly where an untrained coder plays it safest. Closing that gap is what a dedicated coding audit and accuracy review is built to do.

And the cost is large precisely because each instance is small. The Medical Group Management Association has documented that a single-level undercode on an evaluation-and-management visit can cost roughly forty to seventy-five dollars, depending on payer mix and setting. One visit off by a level is nothing; the same drift across every visit, every day, for a year, compounds into six-figure annual leakage for a busy practice. Unlike a denial, none of it gets flagged, appealed, or recovered in the normal course of business. It is just quietly given away, one safe code at a time, which is what makes it the most expensive coding problem a short-staffed practice never notices.

Most groups have already tried the obvious fixes before they talk to anyone. Each one fails the same way: the work lands back on the practice. The pattern, in one table:

The Solution

So what does “someone whose whole job it is” look like on undercoding? The certified coder starts by measuring it, recoding a sample of recent visits blind from the documentation and comparing to what was billed, so the suspicion becomes a rate in levels and dollars. Then they take code selection off guesswork: reading each encounter and coding to the level and billable add-ons the notes actually support, rather than to whatever felt safe to someone untrained. Putting trained selection back on the work is exactly what dedicated medical coding support is built to do, and it stops the downward drift at the source instead of catching it in an audit later.

Then comes recovery on what is still recoverable. For the recent underbilled visits inside their payer’s filing window, the coder confirms the documentation supports the higher level and rebills, working the ones closest to their deadline first. This is real revenue on work already done, and the filing clock is the only thing between the practice and it, so recovery runs deadline-first. Alongside that, documentation gaps that were forcing conservative coding get flagged back to the provider, because a note that looks ambiguous is what makes even a trained coder play it safe.

Behind all of it, AI drafts the first pass and a credentialed human verifies. The workflow reads the encounter, drafts the level and the add-ons, and flags any documentation gap; a certified coder confirms the code against the notes and owns the claim. Every security control that protects the chart data moving through the coding workflow is documented and auditable, and the whole approach is described on our HIPAA and security page, because moving clinical documentation through a coding process is only safe when the controls are real.

Who Actually Does This Work

Fair question: why would an outsourced team code your visits more accurately than your own staff? Because coding to the documentation is their trained profession, not a task shared out when someone left. The people selecting your codes are credentialed medical professionals: overseas-trained physicians, US-licensed nurses and pharmacists, and PharmDs, all trained to US coding standards and specialty workflows. They know the evaluation-and-management levels, which add-ons are separately billable, and how to code to what the note supports without the audit fear that drives untrained staff to underbill. That is not caution standing in for competence; it is competence that codes the visit for exactly what it was.

We are not a call center. We are a clinical operations partner, a healthcare BPO built on dedicated virtual staff: 500+ credentialed professionals, 24/7 coverage, and the AI-first-pass plus human-verify workflow you just read about behind every one of them. A typical practice is live in 1 to 2 weeks, at up to 70% below the cost of hiring locally, and no one on our side goes out without a trained backup already inside your workflow, so code selection never falls back to guesswork because the one certified coder is out.

And the security piece your compliance officer will ask about: we are audited to SOC 2 Type II with zero exceptions and certified for ISO/IEC 27001:2022, HIPAA, and GDPR, with zero breaches in eight years. Every workstation runs inside a secure enclave on US-based servers, with screen captures and downloads blocked by policy, so PHI never sits on someone’s home laptop. Every client account carries a $5M E&O and cyber liability policy and a BAA signed before any work starts; the full detail lives in our HIPAA and security posture.

Put the routine and the people together, and a specific list of things simply stops happening.

How We Permanently Fix the Process

A person alone is not the fix, and neither is a bot alone. The fix is a documented accuracy program: a certified coder owning level and add-on selection on every encounter, a periodic audit sample measuring the undercoding rate so drift is caught early, recovery of recent underbilled visits inside their filing window, and documentation feedback to the providers so ambiguous notes stop forcing conservative codes, all written down and worked the same way every time. Before we code a single visit for a new practice, we audit a sample against the documentation so we can see the real rate, and we build the program against that, not against an assumption.

From there the program becomes a living playbook rather than a one-time cleanup. It records how each visit type should be coded, which add-ons are separately billable in your specialty, the audit cadence that keeps the rate honest, and the documentation prompts that keep notes from forcing downcodes. It is written down, kept current as coding guidelines change, and owned by the team. When your coder is out, a trained backup works the same playbook the same way, so accuracy holds whether or not any one person is at their desk that week.

That is the difference between recovering this year’s undercoding and closing the leak for good, and it is what a dedicated medical coding partner actually buys you. A coder leaving used to mean code selection quietly drifted down until nobody remembered what a visit should bill. Under this model certified selection stays on the work, the playbook stays, the backup steps in, and undercoding stops being the six-figure leak your reports were never going to show you.

The Whole Thing in Four Sentences

A practice undercodes when a coder vacancy gets filled by untrained task-sharing, because uncertified staff fear an audit more than underbilling and systematically pick lower levels and skip billable add-ons, and the claims still pay so nothing flags it. Splitting coding among untrained staff, trusting clean-paying claims, or telling people to code conservatively all fail the same way. The fix is to audit a sample against the documentation to measure the rate, put certified code selection back on the encounters, recode and rebill the recent visits still inside their window, and hold ongoing accuracy so the leak does not return. An OB/GYN practice runs exactly this model with us today, names withheld, no patient data shown.

If you want to check us out before talking to anyone: our security posture is independently auditable, we are an MGMA 2026 Corporate Member, and 800+ providers run back office work with us.

Ready to find out what undercoding is costing you? Try us risk free: two weeks, a real audit of your coded visits against the documentation, certified coders owning selection and recovering what is recoverable, and if it does not earn the handoff, you walk away. From here down is the sales part, and it is short: here is exactly what it costs.

Written By

Dan Nandan

Founder and CEO, Staffingly, Inc. · Piscataway, NJ

Dan Nandan has spent 25+ years in IT consulting and healthcare BPO, was among the first in the US to build an RPO/BPO delivery network in India, and has been featured in Computerworld. He runs the operations and the dedicated virtual teams behind the workflows on this page; the team-voice answers above come from the remote specialists who work them every day.

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