Forensic Billing Analysis

Forensic Audit Active

Real-time AI reasoning engine and clinical-financial reconciliation

Ledger Claims

Claim #VST-1182-90X

Cardiovascular Intervention

ICD-10-CM I21.3 • Patient: Robert Chen (#8821-XC)

2h 14m elapsed in audit

84%

Adjudication ProbabilityHigh Precision Match

Total Discrepancy

-$4,210.00

Recoverable via AI Intercept

$3,850.00

psychology AI Reasoning Engine

Analyzed 1,420 EMR vitals telemetry data points against billed CPT codes. 2 discrepancies identified.

verified_userAutomated Overrule Recommended

Forensic Discrepancy Breakdown

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Upcoding Detection (CPT 92928)

+$2,100.00 Save

Procedure 92928 mapped to severity level 4; AI suggests level 2 based on EMR vitals telemetry during intervention. Patient stabilized within 18 minutes without second stent deployment.

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Bundling Conflict (CPT 99233 + J1644)

+$1,750.00 Save

Oxygen administration and routine heparin IV billed separately from primary surgical code. Potential double-dipping detected under Medicare bundling guidelines (NCCI Edits).

Itemized Audit Ledger

Medication: Heparin 5000U IV

Code: J1644 • Timestamp: 14:22:10 • Qty: 2

$142.00

Verified Clean

Imaging: Contrast Enhanced CT

Code: 75600 • Missing Auth • Dept: Radiology

$1,890.00

Flagged Anomaly

Standard Facility Fee (OR Suite 4)

Code: G0378 • Auto-Matched with OR Log

$2,200.00

Pending Adjudication