Granite County Medical Center Used Avo AI Scribe + E/M Documentation Review to Increase Reimbursement by 16%
How do you make sure every visit is billed at the appropriate E/M level? For Granite County Medical Center, a critical access hospital in rural Montana, answering that question meant hiring billers who reviewed each note for CDI opportunities. Yet, there continued to be a stubborn gap between what happened in the visit and the E/M level recorded.
The hospital implemented Avo’s AI Scribe and E/M Documentation Review to close the gap between great care and revenue capture. The results came quickly: average clinic reimbursement per visit climbed 16%, billing corrections fell by 87%, and the average billing cycle compressed from approximately 9 days down to roughly 5 days. Outpatient claim denials also dropped to zero since implementation.
Why revenue capture lags behind
Healthcare coding is dense. Evaluation and management (E/M) coding guidelines are detailed and frequently updated, and even well-documented encounters reviewed by billing teams do not always map correctly to the appropriate billing level. Inpatient encounter documentation also requires specific elements to support higher-level billing.
At Granite County Medical Center, a small clinical team delivered a wide range of care: acute inpatient episodes, outpatient clinic visits, and skilled rehabilitation. Like many community hospitals, Granite County was living with a persistent gap between the complexity of care delivered and the billing level captured through documentation. In a CAH operating on cost-based Medicare reimbursement, that gap had an outsized impact on revenue and quality. While Granite County's clinical work regularly met the threshold for Level 3 billing, clinician documentation was not consistently capturing the level of detail and severity needed to support that billing level.
AI Scribe and E/M Documentation Review: a powerful combination
Granite County's clinical team already had strong documentation habits. What they needed was a tool that could create precise documentation that accurately reflected care provided, ensuring that billing level was appropriately supported by clinical evidence every time.
With Avo, Granite County recognized the opportunity in moving CDI work upstream, so that coders could focus on genuine exceptions rather than routine correction and reduce clinician queries. Granite County’s clinicians used Avo’s AI Scribe to capture the clinical encounter as it happens and E/M Documentation Review to guide the provider through time- or complexity-based pathways to appropriately elevate E/M billing based on care provided. The billing team now receives notes that are accurate and complete, eliminating the need for time-consuming CDI queries.
Key findings
1. +16% improvement in clinic reimbursement per visit
With Avo, the share of clinic visits billed at the 99214 level (the appropriate code for moderate-to-high complexity encounters) rose from 16.9% to 51% – a more than 200% increase. That single shift was the largest driver of the overall +16% improvement in average clinic reimbursement per visit.
Avo also surfaced coding opportunities the team had not anticipated. Granite County's clinicians were regularly performing laceration repairs, wound care, toenail removals, and similar procedures, but not always coding them at the level the work warranted. E/M Documentation Review helped raise the coding literacy of Granite’s clinicians by flagging a nuance the team had not fully accounted for: any procedure performed in a clinic or emergency setting without conscious sedation, including sutures, staples, incision and drainage, and excision, qualifies as a minor surgical procedure and typically supports Level 4 billing. In a community where roughly 8% of ER visits involve laceration repairs alone, that reclassification represents a meaningful and recurring coding correction with every shift.
2. 87% reduction in billing corrections
In a small rural hospital, a billing team covers more ground per person than their counterparts at large health systems. Before Avo, correcting roughly 80% of submitted notes was consuming most of the Granite billing team’s bandwidth. After implementation, billing corrections dropped to less than 10%, an 87% reduction. For certain providers, the billing team no longer reviews notes before they go out – reflecting trust in Avo’s coding accuracy.
“Avo helps the billing department because they’re not having to dig through our notes,” said Jessica Martin, CMIO at Granite County Medical Center. “It's almost to the point where we don't necessarily need to use it on every single encounter. It's shown me enough about my own notes to help me better categorize levels.”
3. Billing cycle compressed from 9 days down to roughly 5 days
Using Avo, Granite’s clinicians submit more comprehensive notes that reduce billing denials and corrections. As a result, average billing cycle time, measured from note closure to bill issued, fell from approximately 9 days down to roughly 5 days. Granite also achieved zero back-end claim denials in the outpatient clinic after implementing Avo, cutting down on one of the most expensive parts of billing rework.
For a Critical Access Hospital where reimbursement timing has direct operating impact, compressing the cycle by over 40% is significant. Cash arrives sooner, AR ages less, and the billing team is no longer working a backlog of corrections.
A meaningful insurance win on swing beds
Inpatient and swing bed encounters represent a smaller share of total volume at a Critical Access Hospital than clinic visits, but Granite County is seeing directional improvement on inpatient billing levels and a clearer near-term win on swing beds. Swing bed patients, those requiring skilled rehabilitation or IV therapy but not acute hospitalization, must be reauthorized weekly by Medicare Advantage insurers who need ongoing documentation of skilled nursing necessity. Before Avo, that process regularly required follow-up documentation, supplemental notes, or appeals.
Since implementation, those approvals come through with significantly less back-and-forth. For a small hospital where every administrative touchpoint has a real time cost, that reduction in insurance friction compounds.
Closing the gap
Granite County's results reflect what happens when clinical documentation accurately captures care provided. While the clinical team delivers excellent care, Avo ensures that work was translated fully into captured revenue – during the visit itself.
"We went from catching almost none of our Level 3 billing to catching a majority of it. For a Critical Access Hospital like ours, that's real revenue we were leaving on the table every day," said [NAME]. "Avo's AI Scribe and E/M Documentation Review made that possible without adding a single person to my team."
About Granite County Medical Center
Granite County Medical Center is a community-based medical center serving patients across Montana's Granite County and surrounding region. As a critical access hospital and clinic system, the organization is committed to delivering high-quality, evidence-based care close to home for the patients and families who depend on it.
About Avo
Avo's clinician support platform empowers healthcare organizations to standardize care and reduce burnout by effortlessly incorporating guidelines and protocols into the clinical workflow. By centralizing the latest information and transforming it into actionable tools in the EHR (or outside of it), Avo simplifies everyday tasks like pre-charting, care planning, documentation, ordering, and more. At Avo, we improve quality of care with love, not alerts.