Catch the denial before you submit the claim.
FirstPass checks every Medicare wound-care claim against the CMS rules in force: coverage, NCCI conflicts, and MUE limits. It tells you exactly what will deny, and how to fix it.
CMS's Fraud Defense Operations Center used AI to stop those payments before the money ever moved. Its model is “stop and catch,” not “pay and chase.”
For a legitimate practice, a flagged claim is no longer a delayed payment. It's frozen cash and a flag on your NPI. The safest claim is the one that's clean before you submit it.
And 2026 raised the stakes three more ways.
The graft gold rush ended
Medicare spending on skin substitutes grew nearly 40-fold in five years, from $252 million to over $10 billion. On January 1, CMS repriced every product to about $127 per square centimeter. The margin that used to bury sloppy paperwork is gone.
Medicare started acting like an MA plan
In six states, skin-substitute claims now need a yes before you treat, the same prior-auth dance you already know from Medicare Advantage. And asking is “voluntary” the way a toll is voluntary: skip it, and Medicare holds your claim after the work is done and reads your chart before paying anything. Either way, your documentation gets judged before the money moves.
Clean claims are becoming a fast pass
CMS is exploring what it calls “gold carding”: get approved 9 times out of 10 and you could be excused from prior auth entirely. The providers whose paperwork holds up will skip the line. Everyone else waits in it.
Sources: CMS CY 2026 Physician Fee Schedule final rule · Federal Register 90 FR 28749 (WISeR model).
Medicare never sees your patient. It only reads the paper.
Nobody at Medicare reads your chart and disagrees with your care. A computer matches your claim against its rulebook, the one in force on the day you saw the patient, and either pays or goes silent. Almost every wound-care denial is one of three broken links.
The problem
The diagnosis code. It has to be specific: which site, which side, how deep. “Unspecified” is denial bait.
The fix
The procedure code. And here's the part that kills clean claims: the diagnosis has to point at the procedure. Medicare keeps a list of exactly which problems justify paying for which fixes. Right care with the wrong link means no payment.
The tag
The modifier. Two characters that change what the fix means: both legs, left side, notice on file. Miss a required one and the line denies. Use the wrong one and it can deny too.
FirstPass checks all three links on every claim, against the rules that applied on your date of service. It shows you exactly which one is broken and how to fix it, before you submit.
Three steps, before the claim leaves your desk.
Dictate your note, like you already do
Dictate the way you already do, then upload or paste the visit note. FirstPass reads it and builds the claim: codes, date of service, payer. You confirm every code before it lands; nothing you didn't approve goes on the claim.
Every link checked, as of the date of service
Each line is checked against the CMS rules that applied on the day of the visit: the diagnosis-to-procedure link, code conflicts, unit limits, and the modifiers the rules require. Not today's rules. That day's.
Submit clean, and know the number
You get a clear verdict, the exact fix for anything that would deny, and what Medicare will pay, to the dollar. Then you submit it, clean.
One claim checker grew into four checkpoints.
Same promise at each one: catch it before it costs you.
Every code checked against the rules in force on the date of service, and priced to the dollar.
Coverage flips at month boundaries. See who needs a fresh check this month: before the visit, not on the remit.
Know before first touch when a signature is needed, with the reason pre-filled, and a paper trail that protects you even on the clean visits.
Paste a remit. Every denial explained in plain language, with what to do next and the deadline that matters.
Denials are only half the money.
The other half never makes it onto the claim: the second leg you didn't bill because the modifier rules felt risky, the visit time you gave away, the service you couldn't price. FirstPass finds it, and shows you the rule that makes it payable.
The second leg
Wrapped both legs? Your MAC's own rule says that's one line, one modifier, one unit, paid at 150%. That's about $33 more per visit* you may have been writing off because the format was never clear.
The price, before you submit
Every payable line is priced from the same fee schedule Medicare pays from: to the dollar, for your locality, for that date of service. No estimates. No averages. If something can't be priced yet, FirstPass says so instead of guessing.
The denial that never gets appealed
Most “denials” aren't disagreements. They're eligibility problems that were true before the visit ever happened. Coverage flips at month boundaries. FirstPass tells you who needs a fresh check this month, before first touch instead of six weeks later on the remit.
Every number cites its source. If FirstPass didn't check something, it tells you that too. A green light here means it was actually checked.
See what your last 30 claims left on the table* Bilateral compression application, 2026 Medicare fee schedule, Georgia non-facility, NP rate: $65.20 single → $97.81 bilateral. Your locality's numbers will differ. That's the point.
The questions providers ask first.
Is AI picking my codes?
No. Codes are assigned by deterministic rules, the same kind Medicare's own systems run. AI does exactly one job here: it reads your dictated note into structured fields and shows you the sentence each fact came from. You confirm every field before anything touches the claim. A billing code is never chosen by AI.
Where does my patient data go?
FirstPass can run in a mode where patient identity never leaves your own system. The claim is validated against the rules without FirstPass holding your patients. Encryption and a BAA are standard either way.
Do you submit claims for me?
No, and that's deliberate. You certify and submit exactly as you do today, so you stay in control of what goes out under your NPI. FirstPass's job is to make sure that what you send holds together before it leaves your desk.
I already have a biller.
Keep them. FirstPass is the second set of eyes that cites the rule behind every flag, refreshed on a monitored cycle. Your biller gets cleaner claims to work with, and when two opinions disagree, you get the rule text instead of a guess.
Will this slow down my day?
The input is the note you already dictate. FirstPass builds the claim from it and asks only for what's missing, in plain language. Most answers are a tap.
Codes change constantly. How current is this?
That's the product. Every rule is versioned by date of service and refreshed on a monitored cycle: ICD-10 each October, CPT/HCPCS each January, NCCI and fee updates quarterly. The app shows the date your code sets were last verified, so you never have to wonder.
Stop chasing denials. Start submitting clean.
We'll run your last 30 claims through FirstPass and show you exactly what would have denied. Free, and no integration to set up.