Sentinel Clinical Risk Group

Sample audit report

De-identified example showing the format and depth of a real Sentinel audit.

Subject: SUBJ-9D4F2A (de-identified)

Family Medicine · established patient · billed 99214

E/M coding

Billed: 99214 — Supported: 99213 — Status: Overcoded

Medical decision-making detail

  • Column 1 — Problems: one chronic illness, stable. Reaches Moderate.
  • Column 2 — Data: two Category 1 elements. Limited, not Moderate.
  • Column 3 — Risk: routine prescription management. Low.

Sample findings

  • B10: E/M level overcoded — documentation supports Low MDM (99213). Column 1 reaches Moderate (one chronic stable problem), but Column 2 has only two Cat1 elements and Column 3 reflects routine prescription management.
  • B4: Assessment lists three problems but the plan addresses only two — medical-necessity ambiguity for MDM column 1.
  • B7: Suspected copy-forward language from the prior encounter narrative. Recommend documenting the patient's update verbatim.

Capture and exposure

Your full report quantifies each encounter against your practice's own fee schedule — for the audit period only, never projected across multiple years. Under-coded and over-coded encounters are subtotalled separately, as capture and as repayment exposure, and are never combined into one number. Encounters where no figure could be quantified are counted, not omitted.