How a 12-Provider Ophthalmology Group Recovered $340K in Missed Charges

When this ophthalmology group first ran a Syntra retroactive audit, the leadership team expected to find a handful of missed charges. What they found instead was a systematic pattern: established patient visits that met the documentation requirements for 99214 were being billed as 99213, and a meaningful share of diagnostic tests performed in-office never made it onto a claim at all.

Across 18 months of encounters, the audit surfaced roughly $340,000 in recoverable and go-forward revenue. The largest driver was evaluation and management undercoding — the clinical documentation supported higher levels of service, but coders working under volume pressure defaulted to the safer, lower code.

After deploying Syntra as a pre-bill review layer, every chart is now audited before submission. Coders receive specific, cited feedback tied to the documentation, and the practice has seen its average payment per encounter rise without a single change to how physicians document.

The compliance team also benefits: because Syntra flags overcoding with the same rigor as undercoding, the practice has a defensible, consistent audit trail for every claim that goes out the door.