Visit coding
E/M level, ICD-10, CPT, G2211 and modifier 25 are checked against the note. Visits coded too low get flagged, and so do visits coded too high.
For practices in a Medicare ACO
Your ACO runs the program. Rafter gets the visit right.
One flat monthly price per clinician, whether your staff runs Rafter or a Rafter specialist does the work. There is no share of your savings and no charge per diagnosis, query or patient.
Rafter prepares each visit from your own chart and checks the coding before the claim goes out. On Traditional Medicare, complete documentation protects the benchmark your ACO is measured against.
- Free look-back on your own charts, with no commitment
- Month to month. Leave with 30 days’ notice
- Questions to physicians are clinical only, with no dollars
What changes your price
How many clinicians bill visits, and who runs Rafter.
What never does
- Diagnoses or HCCs found
- Queries sent or answered
- Codes added
- Patients on your panel
- Your savings or collections
- Risk scores
- CMS rule changes
We confirm your price on a short call once we know how many clinicians you have and who codes today.
Four kinds of value, each in its own unit.
Your report never adds them into one big number. Each line says what it is and how it reaches you.
Clean claims
NCCI edits, Novitas coverage rules and payer prior-auth lists run before the claim goes out. Your current biller still sends it.
Medicare Advantage documentation
MEAT evidence checks on your Medicare Advantage charts, and a mock RADV in your look-back at your request. Dollar figures appear on those patients only.
Benchmark documentation
Chronic conditions on Traditional Medicare patients are counted. Complete documentation protects the benchmark your ACO is measured against.
One flat price for ACO practices
If your practice is in a Medicare ACO, you pay Rafter one flat monthly price per clinician. We don’t take a share of your shared savings, and nothing in the price depends on diagnoses or patient counts.
Your staff can run Rafter, or a Rafter specialist can do the work for you. The price covers every payer, and it doesn’t change when CMS changes the rules.
Core
- Best for
- Practices with a certified coder or an experienced billing lead on staff
- Who works the pre-visit queue and checks the codes
- Your staff, using Rafter
Managed
- Best for
- Practices where physicians pick their own codes today
- Who works the pre-visit queue and checks the codes
- A Rafter specialist
We expect most small ACO practices to choose Managed, because few have a full-time coder.
The same on both plans
- Payers covered
- Traditional Medicare, Medicare Advantage, commercial and Medicaid
- Term
- Month to month; leave with 30 days’ notice
- Never charged
- A share of savings or collections, anything per diagnosis, HCC, query or patient, or any fee tied to risk scores
Claims submission by Rafter is planned. Until it is live, your current biller sends claims after Rafter’s pre-bill check.
Start with a free look-back on your own charts
Month to month. We confirm your price on a short call once we know how many clinicians you have and who codes today.
Why one flat price
A flat price fits how ACO practices get paid: we earn the same whether a chart holds ten diagnoses or none.
- Your ACO already shares savings with you. We don’t take a second cut, and we don’t price on money that reaches you 2 to 3 years after the visit, if it comes at all.
- On Traditional Medicare, documentation protects the benchmark your ACO is measured against. CMS caps how far coding can raise that benchmark, so we don’t charge as if it pays you directly.
- Nothing in our price goes up when a code, a diagnosis or a query is added. Your physicians decide what is documented and billed.
- Your bill doesn’t change when CMS changes the rules, including the E/M changes proposed for 2027.
What’s included
Both plans include every Rafter engine for every payer. Managed adds a Rafter specialist who does the daily work.
What you get
Core
Managed
Pre-visit prep for every scheduled patient, all payers
Included on both plans
Pre-visit questions to the physician that cite evidence from the patient’s current record, follow the ACDIS/AHIMA query guidelines and always allow “not present”
Core: Rafter drafts, your staff reviews and sends
Managed: A Rafter specialist reviews and sends
Visit coding check: E/M level, ICD-10, CPT, G2211 (or the 2027 E/M modifier if CMS finalizes it), modifier 25
Core: Rafter flags, your coder confirms
Managed: Rafter checks every visit, and a Rafter specialist reviews each flagged one before the claim goes out
Pre-bill claim check: NCCI edits, Novitas coverage rules, payer prior-auth lists
Included on both plans
Payer lanes: every finding is labeled by payer, and Traditional Medicare findings are counted for your ACO benchmark, never priced
Included on both plans
Medicare Advantage documentation defense: MEAT evidence checks on MA charts, and a mock RADV in your look-back at your request
Included on both plans
Users, visits, questions and reports
Unlimited on both plans
EHR connection
athenahealth: Rafter pulls upcoming visits directly, and signed notes come by upload for now. Other EHRs: upload or CSV
Security
Signed BAA and a 10-year audit trail
Not in either plan: quality reporting, care management billing (CCM, APCM, TCM), attribution, wellness-visit outreach and care management. Those stay with your ACO, and Rafter never needs your ACO’s data files.
What visit coding is worth
At 2026 national rates, each visit coded to what the note supports changes Medicare payment by a known amount, up or down. Your free look-back shows how often each applies at your practice.
Core suits practices whose own coder can work Rafter’s findings. Managed takes the work off your team: a Rafter specialist prepares each visit and reviews flagged coding before the claim goes out.
| Change the note supports | Medicare payment difference |
|---|---|
| 99214 instead of 99213 | $40.42 more |
| 99213 instead of 99214 | $40.42 less |
| G2211 added where the care relationship supports it | $17.37 more |
| G2211 removed where it isn’t supported | $17.37 less |
| 2027, if CMS finalizes it: the E/M modifier for MSSP clinicians that replaces G2211 | 32% of the visit: $29.85 on a 99213 or $42.45 on a 99214 at proposed 2027 rates, instead of $17.08 for G2211 |
Rates are national, before your local adjustment, and Medicare Advantage plans pay G2211 unevenly. CMS had not published the final 2027 rule when this was written. We don’t promise a revenue figure before your look-back runs.
Rafter works alongside your ACO.
Your ACO’s tools are built for its contract. Keep them. Rafter covers what they leave to you, and we don’t add a second set of pop-ups.
Stays with your ACO
- Quality reporting
- Care management billing (CCM, APCM, TCM)
- Attribution
- Wellness-visit outreach
- Care management
What Rafter covers
- Visit coding, checked before the claim goes out
- Your Medicare Advantage and commercial patients
- Payer rules, including coverage and prior-auth lists
- The pre-bill check on your claims
- Rafter never needs your ACO’s files. It reads your chart under your own BAA.
- Questions to physicians are clinical only. No dollars, no payer talk and no contract talk, and they can always answer “not present.”
- Bring your ACO’s quality lead to the call. We like those meetings.
Each patient’s coverage decides what your look-back shows.
Rafter reads each patient’s coverage, so one panel can show dollars on some patients and counts on the rest.
| Patient’s coverage | HCC findings show as | Where your practice sees value |
|---|---|---|
| Traditional Medicare, in your ACO | A count, labeled as protecting the benchmark | E/M level, G2211, clean claims |
| Medicare Advantage | Dollars, on those patients only, once their dual status is known | Documentation that holds up in an audit, plus the visit |
| Commercial or Medicaid | A count | E/M level, clean claims |
| Payer not confirmed | A count, until someone confirms the payer | Held out of every HCC dollar figure |
First ACO practices: founding-partner terms
The first 3 ACO practices that sign by March 31, 2027 get founding-partner terms. We stop at 3 because Managed runs on Rafter specialist hours.
- Free ACO look-back. We run 30 days of your past charts through Rafter under a signed BAA and walk your physicians through what it found. No commitment. If the look-back finds past claims coded higher than the note supports, we flag them so you can review and correct them.
- 30 days live at no charge. The 30 days start the day your first live pre-visit queue runs.
- A founding credit for the first 12 paid months. We go through the numbers on the call.
- Setup on us. Founding partners pay no setup fee.
- Price lock. After the credit year you pay the lower of today’s list price or the current one, through December 31, 2028.
- Day-90 review. We go through the numbers together at day 90. You can leave at any point with 30 days’ notice.
What we measure together
| What we measure | Why it matters |
|---|---|
| E/M levels changed, counted both up and down | Shows accuracy, not just lift |
| G2211 added and declined (the E/M modifier from 2027, if finalized) | Shows the relationship test is applied, not blanket billing |
| Pre-visit questions sent, answered, and answered “not present” | A steady share of “not present” answers shows the questions don’t lead |
| Claims fixed before submission, and denials against the 3 months before go-live | Shows the pre-bill check is paying for itself |
| Medicare Advantage diagnoses supported by MEAT evidence | Shows MA documentation will hold up in an audit |
| Traditional Medicare documentation completeness, as counts | Protects the benchmark your ACO is measured against |
How the price works
Each clinician who bills visits under your TIN in a month counts once for that month.
- Who qualifies
- A practice whose TIN is on this year’s Medicare Shared Savings Program or LEAD participant list. If you leave your ACO, this price runs through December 31 of that year, and we agree the next year’s price with 60 days’ notice.
- Who counts
- Any MD, DO, NP or PA who bills E/M visits under the practice’s TIN that month.
- Part-time
- A clinician with fewer than 150 E/M and wellness visits billed under their own NPI in the month, all payers, is half price. No billed visits means no charge.
- Minimum
- None, so a solo practice pays for one clinician.
- Rule changes
- CMS updates, including ICD-10 every October 1 and the 2027 E/M changes, are included at no extra charge.
- Leaving
- 30 days’ notice. We export your data within 10 business days and return or destroy patient data as your BAA requires.
Questions practices ask
These are the answers we give on calls, written down.
How do you price for ACO practices?
One flat monthly price per clinician that covers every payer. It doesn’t change with what we find, and a clinician who bills fewer than 150 visits in a month is half price. We confirm your price on a short call once we know how many clinicians you have and who codes today.
Do you take a share of our shared savings?
No. Your ACO shares savings with you, and we stay out of that. Our price isn’t tied to diagnoses, risk scores or collections.
Why not charge a share of what you find?
On Traditional Medicare, diagnosis findings mostly protect your ACO’s benchmark rather than paying you directly. A flat price keeps our fee the same whatever the chart shows.
Will this raise our shared savings?
We won’t promise that. CMS caps how far coding can raise a benchmark. We protect against your benchmark sliding because the notes didn’t support what you treated.
We’re in an ACO. Does Rafter replace its program?
No. Rafter works alongside your ACO. It prepares each visit from your own chart and checks the coding before the claim goes out, so the notes behind your ACO’s risk score hold up. That protects the benchmark your ACO is measured against.
Our ACO gives us tools at no charge. Why pay for this?
Your ACO’s tools are built for its contract. Rafter covers what they leave to you: visit coding, your Medicare Advantage and commercial patients, payer rules and claims. Keep your ACO’s tools; we don’t add a second set of pop-ups.
Are we even allowed to use Rafter?
Federal ACO rules don’t restrict your own vendors, but check your participation agreement. We’ll give you four questions to send your ACO in writing. Rafter reads your chart under your own BAA and never needs your ACO’s files.
Why no dollar figure on Traditional Medicare HCCs?
Because HCCs pay nothing directly on Traditional Medicare, so a dollar figure there would be an inflated number. Those findings are counted instead, and the report says what they do: complete documentation protects the benchmark your ACO is measured against.
We see Medicare Advantage patients too.
The price covers them. Rafter reads each patient’s coverage, so one panel can show dollars on its Medicare Advantage patients and counts on everyone else. If the payer or dual status isn’t confirmed, the finding stays a count.
What if it doesn’t find much?
You’ll know before you pay. The free look-back runs on your own charts, and a founding partner’s first 30 live days cost nothing.
What if we change ACOs?
Rafter is yours, not your ACO’s, so it stays with you.
What happens in 2027?
If CMS finalizes the new E/M modifier, Rafter switches over on January 1 at no extra charge.
Is there a long contract?
No. A month-to-month order form and a BAA. Leave with 30 days’ notice.
Which ACO programs do you work with?
The Medicare Shared Savings Program and LEAD. ACO REACH ends at the end of 2026 and LEAD starts January 1, 2027, so if you’re in REACH today, tell us on the call. Not sure how your practice participates? Pick “Not sure” on the form.
Thirty days of charts. One 15-minute call. Your visit revenue, in dollars.
Tell us a little about the practice and we’ll come prepared. HCC findings on Traditional Medicare patients come back as counts, never as a dollar figure.
- 15 to 20 minutes, on your calendar, with a specialist
- See how the look-back works with your EHR: signed notes come by upload or CSV for now
- Leave with a clear yes or no on whether your practice is a fit. Either answer is fine