Schave Health Advisory
Healthcare Coding, Compliance & AI Advisory
Why Provider-Side?
Schave Health Advisory is intentionally focused on provider-side coding, audit, compliance, and documentation support. The work is centered around professional fee and facility outpatient environments, where coding accuracy, E/M leveling, documentation alignment, provider education, and workflow clarity directly impact both compliance and financial performance.
Rather than taking a broad or generalized approach, this focus allows for deeper understanding of the operational, clinical, and documentation challenges that provider organizations face every day — and more targeted, practical support for addressing them.
01
Coding Quality and Audit
Accuracy, consistency, and audit readiness.
Provider-side coding quality depends on accurate procedure and diagnosis coding, correct E/M leveling, and documentation that supports the services billed. This work focuses on identifying coding accuracy issues, building structured audit programs, and creating accountability across professional fee and facility outpatient coding environments.
Procedure and diagnosis coding audits
E/M leveling review and accuracy assessment
Quality assurance program design and implementation
Audit readiness assessment and remediation planning
Outcome
Improved coding accuracy, stronger audit readiness, and more consistent documentation quality across ED, hospital medicine, urgent care, and primary care settings.
How This Typically Looks
A physician group engaged Schave Health Advisory to review a sample of professional fee encounters across primary care and urgent care settings. The review identified E/M leveling inconsistencies and documentation patterns that did not support the level of service billed. Findings were used to develop a targeted provider education plan and a structured audit monitoring process.
Typical Engagement Timeline
Week 1
Initial discussion, scope definition, and data or sample access
Weeks 2–3
Coding and E/M audit review, documentation assessment
Week 3–4
Findings summary, recommendations, and discussion
Optional
Follow-up education, monitoring, or additional review
Timelines are illustrative. Actual scope and duration are defined based on each engagement.
02
Compliance and Documentation Risk
Provider-side compliance grounded in real coding practice.
Compliance risk in provider-side coding environments is often rooted in documentation gaps, E/M leveling inconsistencies, and coding practices that have not kept pace with regulatory and payer requirements. This work focuses on identifying that risk and building structured programs to address it.
Provider-side compliance program development and assessment
Coding and documentation risk review
OIG, CMS, and payer guideline alignment
Provider education and corrective action planning
Outcome
Reduced compliance risk and stronger alignment between documentation practices, coding accuracy, and regulatory requirements.
How This Typically Looks
An outpatient coding program identified recurring documentation gaps that created compliance exposure across multiple provider types. Schave Health Advisory conducted a focused compliance review, assessed coding practices against current OIG and CMS guidance, and supported the development of a corrective action plan with provider-specific education components.
Typical Engagement Timeline
Week 1
Scope definition, data access, and baseline documentation review
Weeks 2–3
Compliance review, coding practice assessment, and risk identification
Week 3–4
Findings, corrective action recommendations, and discussion
Optional
Provider education, corrective action support, or ongoing monitoring
Timelines are illustrative. Actual scope and duration are defined based on each engagement.
03
AI Coding Workflow and Validation
Real-world validation for AI-driven coding tools.
AI-driven coding tools require deep provider-side coding expertise to validate accurately and deploy responsibly. This work supports organizations building or scaling coding automation by ensuring their solutions align with coding standards, compliance requirements, and real clinical workflows in professional fee and facility outpatient settings.
AI coding output validation for procedure, diagnosis, and E/M accuracy
Workflow design and integration support
Collaboration with product and engineering teams
Alignment with provider-side coding and compliance standards
Outcome
Coding AI that performs accurately in real-world provider environments and meets compliance and reimbursement requirements.
How This Typically Looks
A healthcare technology company building an AI-assisted coding platform needed provider-side validation of its output before client deployment. Schave Health Advisory reviewed coding suggestions across ED and facility outpatient encounter types, identified misalignments with professional fee coding standards, and worked directly with the product team to refine the model's accuracy and workflow integration.
Typical Engagement Timeline
Week 1
Workflow review, data access, and alignment on validation scope
Weeks 2–3
AI output review across encounter types, accuracy and compliance assessment
Week 3–4
Findings, workflow recommendations, and team discussion
Optional
Ongoing validation support, quality oversight, or process refinement
Timelines are illustrative. Actual scope and duration are defined based on each engagement.
04
Provider Education and Documentation Improvement
Closing the gap between documentation and coding accuracy.
Many coding accuracy and compliance issues trace back to documentation that does not support the level of service billed or the diagnosis coded. This work focuses on targeted provider education and structured feedback programs that improve documentation quality and reduce coding risk at the source.
Provider-specific education on E/M documentation requirements
Diagnosis and procedure coding documentation guidance
Feedback and education programs for coding teams
Corrective action planning tied to audit findings
Outcome
Stronger documentation quality, improved coding accuracy, and reduced compliance exposure across provider and coding teams.
How This Typically Looks
Following a coding audit that identified documentation deficiencies across an emergency medicine group, Schave Health Advisory developed provider-specific education sessions addressing E/M documentation requirements, diagnosis coding clarity, and common documentation patterns that create compliance risk. Education was tied directly to audit findings to make feedback practical and actionable.
Typical Engagement Timeline
Week 1
Review of audit findings, documentation samples, and education scope
Weeks 2–3
Development of provider-specific education materials and feedback
Week 3–4
Education delivery, discussion, and documentation guidance
Optional
Follow-up review, additional sessions, or ongoing feedback support
Timelines are illustrative. Actual scope and duration are defined based on each engagement.
05
Coding Operations and Client Delivery
Structured delivery across provider-side coding programs.
Consistent coding performance depends on clear processes, defined quality standards, and operational structures that scale without losing accuracy. This work focuses on building the frameworks that allow coding and compliance teams to deliver reliably — for internal operations and client-facing programs alike.
Coding operations structure and workflow design
Quality assurance and performance monitoring frameworks
Client delivery and implementation support
Team scaling and coding quality consistency
Outcome
More consistent coding and compliance delivery, stronger client relationships, and scalable team performance.
How This Typically Looks
A revenue cycle organization supporting multiple physician group clients was experiencing inconsistent coding quality and unclear delivery expectations. Schave Health Advisory assessed the existing operations structure, identified workflow and quality gaps, and supported the development of a more consistent framework for coding quality oversight and client communication.
Typical Engagement Timeline
Week 1
Operations review, workflow assessment, and scope definition
Weeks 2–3
Gap analysis, quality framework review, and delivery structure assessment
Week 3–4
Recommendations, framework design, and implementation discussion
Optional
Implementation support, team guidance, or ongoing quality oversight
Timelines are illustrative. Actual scope and duration are defined based on each engagement.
Example AI-Assisted Engagements
The following scenarios illustrate the types of support Schave Health Advisory provides when working alongside organizations that use or are evaluating AI-assisted coding tools.
01
Output Review & Accuracy Assessment
Reviewing AI-generated procedure, diagnosis, and E/M coding suggestions against provider documentation to assess accuracy and identify patterns that fall outside professional fee and facility outpatient coding standards.
02
Documentation Gap Identification
Identifying cases where AI suggestions do not align with provider notes — flagging documentation deficiencies that require provider education or workflow adjustment before coding can be finalized.
03
Internal Quality Process Support
Helping internal quality and compliance teams develop audit and review processes that account for AI-assisted coding environments, including defining where human review remains required.
04
Workflow Integration Advisory
Advising on how to integrate AI coding tools into existing workflows without disrupting coding accuracy, compliance standards, or provider documentation alignment — particularly in E/M-heavy outpatient and professional fee settings.
These examples are illustrative. Actual engagement scope is defined based on each organization's specific situation and needs.
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Let's discuss your specific challenges and how advisory support can help.
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