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E&M services are among the most frequently billed codes in any plan but understanding whether they’re appropriate requires more than reviewing a chart or two. Penstock analyzes provider-level coding behavior at scale, flagging when E&M levels trend higher than clinical expectations or peer norms. From there, we transform complex analytics into guidance that makes sense to providers, supports constructive conversations, and drives measurable improvement.
Services: Upcoding Prevention Program
Protect your plan from
invisible cost creep.
invisible cost creep.
Small shifts in E&M coding can compound into significant, unnecessary spend— and too often go unnoticed. We find those patterns early and work with our clients and their providers through clear education and evidence-based feedback to correct behaviors and avoid future unnecessary costs.
What We Do
Turn provider-level coding trends into clear signals your team can act on.
Spot what others overlook
Our analytics highlight true coding outliers, not just high billers, so plans can focus on providers whose patterns meaningfully diverge from expected norms.
Bring providers the clarity they need
We create provider-ready summaries that clearly outline what was billed, what guidelines support, and how behavior compares to peers, removing ambiguity and defensiveness.
Make changes stick long term
Scheduled re-audits track whether coding accuracy improves and stays aligned with expectations, reinforcing better habits and preventing future drift.
Why Health Plans Choose Penstock for Upcoding Prevention
Because unchecked patterns become costly ones.
When the details matter most, plans rely on Penstock to reveal what others miss and deliver findings they can act on with confidence.
Visibility that drives real action
We surface coding patterns that matter, patterns tied to spend, risk, and long-term documentation behavior, not noise or false positives.
Provider engagement that works
Our summaries and education materials make issues understandable, actionable, and easy for providers to correct, reducing abrasion and improving compliance.
Evidence plans can stand behind
Every insight is grounded in guidelines, comparative data, and client-specific rules, giving your team a defensible foundation for outreach and follow-up.
Change that persists
Ongoing monitoring ensures improvements are sustained, helping plans avoid recurring overspend and maintain network-level coding accuracy.
Next Steps
Stop coding drift before it compounds.
Upcoding prevention isn’t a one-time fix—it’s an ongoing discipline. Penstock helps plans identify coding drift early, engage providers with clear evidence, and sustain improvements that protect payment accuracy over time.
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