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Audit-Defensible
HIPAA Compliant

Every visit, fully coded. Every dollar, defensible.

From the EMR to the audit trail. One agent, with citations.

Layrd takes every visit a provider closes and produces a complete, defensible coded chart within minutes. E&M with MDM justification, optimized assessments with HCC mapping, care-gap closure, practice-wide dashboards, and a reference-pinned audit trail. The physician reviews and approves each recommendation. Every line cites the chart that supports it.

See how it works
Cited to the chart on every lineBidirectional EHR syncReference-pinned audit trail
Coded Visit · John Doe, 65M · Medicare Advantage
E&M Recommendation
Billed99213
+1 level
Recommended
99214
MDM Scorecard
CMS 2-of-3
Problems addressed
Moderate
Data reviewed
Limited
Risk of mgmt plan
Moderate
Overall → 2nd highestModerate · 99214
hpi.md:p2labs/creatinine_trend.mdmeds/warfarin.md+9 more
Practice rev, this visit+$58
HCC capitation, annual+$740 / yr
Trace ✓
The architecture

Three places, one agent.

The same reasoning works on a single visit, rolls up across the practice, and runs the long-running work between visits, with one shared audit trail.

On every visitThe coded chart

Every closed visit opens as a chart with 8 panels.

  • E&M with MDM justification
  • Optimized assessment list
  • Care gaps across all programs
  • Add-on services + modifiers
  • Pre-submission validators
  • Visit-level dollar impact
  • Reasoning trace
  • Attestation + override + audit hooks
Across the practiceThe dashboards

Manager view, drill-through to every encounter.

  • Population dashboard
  • HCC dashboard with RAF tiers
  • Care-gap dashboard
  • MIPS projection
  • Batch coding across cohorts
  • Filterable by org · sub-practice · provider · payer · program · date
Between visitsOngoing workflow

Everything that doesn’t happen in the exam room.

  • Care-gap closure pipeline
  • Attestation queue
  • Practice settings
  • Payer policy ingestion
  • Care-management revenue tracking
  • Audit log + reference-data pinning
  • Daily coding queue

One memory layer · one audit trail · one source of truth for every recommendation.

On every visit

The coded chart. Eight panels. One source of truth.

Every visit a provider closes opens as a chart with 8 panels. Each panel is a recommendation, never an execution, with the chart evidence behind it. The physician approves, modifies, declines, or defers.

01E&M coding

MDM-justified, with the time path in parallel

The recommended E&M sits next to the billed code, scored on the 3 CMS MDM elements: problems addressed, data reviewed, risk of management. Each tiered with chart-quoted rationale. When physician time is documented, the time path runs in parallel and the higher wins.
  • Overall level = 2nd-highest of the 3 elements (CMS 2-of-3 rule)
  • Gaps that would support a higher level, surfaced
  • Overstatements that risk a downcode on audit, surfaced
Panel 1 · E&M Coding · John Doe
Billed99213
Recommended
99214
MDM scorecardCMS 2-of-3 rule
Problems addressed
Moderate

“3 chronic w/ exacerbation”

Data reviewed
Limited

“BMP + CMP + 2 prior notes”

Risk of mgmt plan
Moderate

“Rx mgmt of warfarin”

Time path: 23 min documented → also supports 99214 · higher of the two wins.
Overstatement risk: “high-risk procedure” phrasing unsupported by chart. Flag before sign-off.
02Optimized assessment list

More accurate, more specific, more complete

The agent rewrites the assessment list pulled forward from the prior note. Every unspecified ICD-10 is upgraded where the chart supports it. Combination codes replace separate codes where the payer requires it. V28 HCC and RAF roll up against the patient’s demographic baseline.
  • Specificity upgrades cited to the chart sentence
  • Combination coding (payer- and HCC-aware)
  • HCC suspects surfaced via MEAT criteria from the full chart
  • Inactive / 24mo-stale conditions flagged
Panel 2 · Assessment list · diff view
Pulled forward
E11.9 · DM, unspecified
I10 · HTN
N18.30 + E11.22
Optimized
E11.65
HCC 37+0.166
I11.0
HCC 224+226+0.300
N18.32
HCC 329+0.302
HCC suspects to consider
I73.9: PAD suspected (ABI 0.72, vascular study 4mo ago)
cited: vascular_study_2026.md:p2HCC 264 · +0.288
Encounter RAF
1.247current1.836w/ suspects
demo: 0.456
03Care gaps

Every measure the patient is in the denominator for

Separated by program: MIPS · HEDIS · CMS Stars · Medicaid Core Sets · ACO measure sets · USPSTF Grade A/B · disease-specific guidelines (ADA, ACC/AHA, GOLD). Routed to the right measure set by the coverage on file.
  • 6 closure states: open · closed at visit · closed by extrinsic · refused · excluded · doc gap
  • CPT-II numerator codes appended automatically when the visit closes a gap
  • Drill into the measure spec, chart evidence, and closure deadline
Panel 3 · Care gaps · John Doe
HEDIS · CDC
HbA1c control >9%
CPT-II 3046F auto-appended
Closed at visit
USPSTF · A
Colorectal screening
Cologuard result · 2 wks ago · cited
Closed (extrinsic)
HEDIS · SUPD
Statin for diabetes
Atorvastatin 40mg · active
Compliant
MIPS · Q236
Controlling High BP
BP 142/88 today · re-check 2 wks
Due soon
6 closure states · open · closed at visit · closed by extrinsic · refused · excluded · doc gap
04Add-on services

Every billable code the encounter qualifies for

Outside the office E&M: Annual Wellness Visit (G0402/G0438/G0439) · G2211 longitudinal add-on · care-management (CCM · PCM · RPM · BHI · TCM · APCM) · modifiers · CPT-II numerator codes.
  • Each gated on the documented work + payer policy
  • Dollar value at the patient’s rate
  • One-line rationale per code
Panel 4 · Add-ons this encounter qualifies for
CodeRationale$
G2211
Longitudinal-care add-on
Established relationship · no Mod 25 · no global day+$16.05
99490
CCM 20+ min
22 min logged this month · on track+$62.16
3046F
CPT-II numerator
Auto-appended for HbA1c gap closure
G0439
Annual Wellness Visit
Eligible: 14 months since last AWV+$172.81
Modifiers: 25, 59, 24, 57 + full CPT/HCPCS range as documented+$251.02
05Pre-submission validators

Every edit the payer enforces, run before the queue

NCCI procedure-to-procedure · NCCI MUE · ICD-10 Excludes1 · payer coverage on DOS · duplicate-claim against history · Mod 25 / G2211 gates. A finding flags the line. It never blocks the claim.
  • Revise · add documentation · override (with reason → audit trail)
  • Practice keeps final authority on every line
  • Edits versioned per payer; pinned to time of service
Panel 5 · Pre-submission validators · running…
NCCI procedure-to-procedurepass
NCCI medically unlikely edits (MUE)pass
ICD-10 Excludes1 conflictspass
Payer coverage on DOSpass
Duplicate-claim against last 90dpass
Modifier 25 gateflag

Mod 25 finding: recommend removing. No separately identifiable E&M from preventive service.

Findings flag, never block. Override logs to audit trail.

06Visit-level dollar impact

Five categories, kept separate because they pay differently

Practice revenue · HCC payer capitation · quality bonus · cost avoidance · informational. Every figure carries a methodology citation so any number on any rollup is defensible against an auditor.
  • Practice revenue valued at the CMS fee schedule for the locality and specialty
  • HCC capitation valued at MA RAF dollars
  • Quality bonus at the practice’s current Stars / MIPS percentile
Panel 6 · Dollar impact · 5 categories
Practice revenue+$58this visit, CMS PFS
HCC capitation+$740annual, if attested
Quality bonus+$0.84Stars decile
Cost avoidance+$220denials prevented
Informational1doc correction

Methodology cited on every number. Any figure on any rollup is defensible against an auditor.

07Reasoning trace

What the agent looked at, cited, validated, and published

A side panel showing the chart documents read, the CMS guideline sections cited, the ICD-10 and HCC references used, the validators run, and the findings published. Browsable and exportable.
  • Physician questioning a recommendation can see the chain of evidence
  • Coder defending a claim under audit has the full trace
  • Exportable to PDF or CSV per visit or per cohort
Panel 7 · Reasoning trace
Exportable
12
documents read
4
CMS sections
6
validators
11
findings
doc
echo_2024.md
EF 38%, BNP 412 → supports I11.0
ref
CMS V28 → HCC 224
Hypertensive heart disease w/ HF
doc
vascular_study_2026.md
ABI 0.72 → PAD suspect (I73.9, HCC 264)
val
NCCI MUE check
99214 + G2211 + 99490 → all within unit limits
ref
CMS IOM 100-04 Ch 12 §30.6.7
G2211 gate: ✓ longitudinal · ✓ no Mod 25
08Attestation + override + audit

Four actions on every recommendation, and a learning loop

Approve · modify · decline (required reason) · defer (to the attestation queue). After 3 consecutive declines of the same suspect with the same evidence, Layrd offers a permanent override, logged with the reason, so it stops re-surfacing.
  • Decline reasons flow to a per-organization audit log
  • Permanent overrides tied to user, timestamped
  • Every override is reversible from the audit trail
Panel 8 · Attestation actions
Every recommendation has 4 actions:
Learning loop

After 3 consecutive declines of the same HCC suspect with the same evidence, Layrd offers a permanent override, logged with the reason, so it stops re-surfacing.

Decline reason → audit trail · timestamped · user-tiedAudit ✓
Across the practice

Three dashboards. Every figure drills to the encounters behind it.

Filterable by provider, payer, program, and date range. Every figure drills to the encounters behind it.

01 · Population

The panel-wide view

Every coded visit, deduplicated to one row per patient. Every number drills to the encounters behind it.

  • · KPIs: panel size, visits, revenue, capitation, gap closure, agent spend
  • · Sections: E&M distribution, HCC capture, per-program gap closure
  • · Batch coding: select a cohort, run the agent across all uncoded visits
  • · CSV export on every table
Population dashboard
ScopeYour practice · all providers·All sub-practices ▾All providers ▾All payers ▾All programs ▾This month ▾
Active panel
1,287
+24 mo/mo
Visits
412
this month
Practice rev
$84K
captured this mo
HCC capitation
$186K
YTD
Gap closure
78.4%
↑ 4.2 pts
E&M distribution, established patients
99212
6%
99213
41%
99214
38%
99215
15%
Batch coding42 uncoded visits in selected scope. Run the agent across all.
HCC dashboard
ScopeYour practice · all providers·All sub-practices ▾All providers ▾All payers ▾All programs ▾This month ▾
Avg curr RAF
1.247
Avg potl RAF
1.836
Annual opp
$184K
suspect pool
Patients w/ opp
412
Recapture
68%
vs last year
RAF distribution
Low (< 1.0)361 patients
Medium (1.0–2.0)695 patients
High (> 2.0)231 patients
Top 10 HCCs by frequency
HCC 37DM w/ chronic comp
142
HCC 224CHF
87
HCC 329CKD stage 3
71
HCC 280COPD
56
HCC 155Major depression
49
5-year recapture (top by RAF impact)
HCC 224 · CHF
recaptured92%
HCC 329 · CKD3
pending67%
HCC 37 · DM comp
recaptured88%
HCC 264 · PAD
gap41%
HCC 280 · COPD
recaptured79%
02 · HCC risk adjustment

Risk capture for the year, and the revenue still on the table

Current RAF vs. potential RAF if every suspect were attested. Annual opportunity from the suspect pool. Recapture against last year’s captures.

  • · RAF tiers: Low (<1.0) · Medium (1.0–2.0) · High (>2.0)
  • · Top 10 HCCs by frequency for the practice
  • · 5-year recapture status sorted by RAF impact
  • · Suspect-conditions grouped by HCC for assigning attestation work
03 · Care gaps + MIPS projection

Quality performance and the dollars behind it

Every measure the practice reports against, with per-measure compliance and patient drill-downs. A separate MIPS projection report flags where small closure gains move the practice into a higher benchmark decile.

  • · Eligible / compliant / due-soon / overdue / excluded / unknown per measure
  • · Patient list sorted by who’s closest to closing
  • · MIPS category breakdown: Quality · PI · IA · Cost
  • · Dollar impact on practice Medicare Part B revenue
Care-gap dashboard
ScopeYour practice · all providers·All sub-practices ▾All providers ▾All payers ▾All programs ▾This month ▾
Measures
47
tracked
Avg compliance
76.2%
Open gaps
187
Critical (<50%)
6
MIPS projection
82.4 pts
at current pace
Per-measure performance
MeasureEligibleCompliantRate
HEDIS · CDC HbA1c control14211077.6%
HEDIS · SUPD Statin DM1189277.9%
MIPS Q236 · Controlling High BP28721876.0%
USPSTF A · Colorectal screening61448879.5%
NCQA · CBP screening1,04182279.0%
MIPS projection · current pace
82.4 pts
decile-impact analysis →
Quality
38
Promoting Interop.
19
Improvement Activities
14
Cost
11

Closing 12 more BP-control gaps moves the practice into the next benchmark decile. Estimated +$8.4K Part B impact.

Between visits

Seven tools for the work that doesn’t happen in the exam room.

Gap closure that accepts faxes as evidence. An attestation queue ordered by dollar impact. Payer policies that ingest themselves into enforceable rules. Care-management revenue tracked monthly. And every change logged to an audit trail that pins the reference data used at the time of service.

Featured · 01

Care-gap closure pipeline

Gaps that can’t close at the encounter become tracked closure attempts with a state machine. Extrinsic evidence (Cologuard results, colonoscopy reports, mammograms) runs through Layrd document triage and closes the gap automatically with a citation.

  • · States: pending · complete · refused · pending data · cancel
  • · Re-evaluates a patient’s gap list when coverage or diagnoses change
  • · Outreach queue tracks patients needing contact
Care-gap closure · pipeline
Pending
Pending data
Complete
Refused
Cancel
Extrinsic evidence in
Fax inbox
Cologuard result · Jane Doe
→ matches USPSTF · Colorectal screening
Closed
Lab interface
BP cuff reading 128/82
→ matches MIPS Q236 · BP control
Closed
HIE
Mammogram report · Jane Smith
→ matches HEDIS · BCS
Pending data

Cologuard, colonoscopy reports, mammograms that arrive by fax run through Layrd document triage. When they satisfy a numerator, the gap closes automatically with a citation. Outreach queue tracks the patients still needing contact.

Payer policy ingestion · UHC · Mod 25 conditions
Source doc · uploaded PDF

…Modifier 25 may be appended to an E&M service when, on the same day a procedure with a global period of 0 or 10 days is performed, the E&M service is significant and separately identifiable from the procedure. The medical record must support distinct documentation of the…

Timely-filing window: 90 days from DOS. Prior auth required for…

Extracted structured rules
Mod 25 requires distinct documentation
cited to source ¶conf 0.94
Same DOS + 0/10 day global only
cited to source ¶conf 0.91
Timely filing: 90 days from DOS
cited to source ¶conf 0.98
Prior auth: list of CPTs (12)
cited to source ¶conf 0.87
Review against source · activate · versioned per payer · revertable
Featured · 02

Payer policy ingestion

The manager uploads a payer’s policy document. Layrd extracts the structured rules: accepted codes, required modifiers, exclusions, the timely-filing window, Mod 25 conditions, prior-auth requirements. Shown next to the source text for review before activation.

  • · Once active, rules apply to every subsequent visit under that payer
  • · Violating claims flagged with the rule citation
  • · Deactivate, replace, or revert. Every change logged.
Five more tools that run between visits
03Workflow

Attestation queue

Every recommendation across every visit the provider hasn’t yet acted on. Sortable by type, visit date, patient, and dollar impact.

Work the high-value suspects first.

04Workflow

Practice settings

Programs enrolled, performance year, site type, ACO participation, payer contracts, provider rosters, care-management enrollment.

Every change timestamped, tied to the user.

05Workflow

Care-management revenue

CCM, PCM, RPM, BHI, TCM, APCM tracked monthly against time and consent thresholds. Billing report by program, provider, and patient.

Eligible, on track, or ineligible. At the plan rate.

06Workflow

Audit log + reference pinning

Every decision logged. Every reference version (CMS-HCC, MIPS, HEDIS, ICD-10) pinned to the analysis at the time of service.

A claim coded 2 years ago is still defensible against the rules in force then.

07Workflow

Daily coding queue

The day’s visits grouped by status. Pulled from eClinicalWorks, coded, in the run queue, with open recommendations, ready to bill.

One action runs the agent across the day’s batch.

Why it holds up

Any number on any rollup, defensible against an auditor.

The agent recommends. The practice approves. Every line has a paper trail. Every dollar has a citation. Every override is reversible.

01Reasoning trace

Every line cites the chart that supports it

A side panel shows the documents read, the CMS guideline sections cited, the ICD-10 and HCC references used, the validators run, and the findings published. Browsable and exportable per visit or per cohort.

Physician questioning a recommendation can see the chain of evidence. Coder defending a claim under audit has the full trace.

02Audit log

Every decision logged. Every override reversible.

Coding decisions, overrides, policy ingestion, settings changes: written to a per-practice audit log, exportable as CSV. Permanent overrides are tied to the user and the reason, and stay reversible from the audit trail.

When CMS or NCQA publishes a new version, the practice stages it, compares it against pending visits, and promotes or reverts.

03Reference-data pinning

The rules in force then are still the rules now

Every reference version (CMS-HCC, MIPS, HEDIS, ICD-10) is pinned to the analysis at the time of service. A claim coded 2 years ago is still defensible against the rules that applied at the time it was coded.

Updates are opt-in. Versions never silently shift under your audit history.

Built for audit defense, not audit risk.

HIPAA-compliant. BAA-signed. AES-256 encrypted in flight and at rest. Every decision tied to a user, a timestamp, and a reason.

Coming Soon

Be among the first to code with Layrd.

We are finishing the final builds. Join the waitlist and we will reach out the moment Coding & Analytics opens for your practice.

HIPAA · BAA · AES-256Bidirectional EHR syncAny size practice