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get_billing_coding_risk

Read-only

Use when assessing coding compliance risk before an OIG audit, preparing for a RAC review, or building a revenue integrity program. Returns E/M distribution benchmarks, upcoding risk signals, OIG audit priority themes, and RAC watchlist. Example: Cardiology practice E/M mix at 67% level 4/5 visits vs 48% national benchmark — flagged HIGH upcoding risk — OIG cardiology audit focus active in 2024-2025 cycle. Source: CMS and OIG compliance composite. $0.02 USDC per call.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
specialtyNo
annual_claim_volumeNo
level_4_5_percentageNoPercentage of E/M claims at level 4 or 5

Schema Changelog

Changes observed during successful MCP inspections.

  1. Added

TDQS

A4.1/5.0
Behavior4/5

Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?

Annotations already declare readOnlyHint=true and destructiveHint=false. The description adds useful context: the source (CMS/OIG composite), an illustrative HIGH-risk example, and the $0.02 USDC cost. It doesn't describe response structure or pagination, but the safety profile is already covered by annotations.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness4/5

Is the description appropriately sized, front-loaded, and free of redundancy?

The description is well front-loaded with use cases, then outputs, then a concrete example, then source/pricing. Each sentence serves a distinct purpose; it is slightly wordy but not padded.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness4/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

With no output schema, the description lists the returned categories and provides an end-to-end example connecting inputs to a risk verdict. It does not specify exact output shape or whether parameters are required, but for a read-only benchmark tool it is adequate for an agent to invoke correctly.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters3/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

Schema coverage is only 33%, so the description must compensate. The Cardiology example clarifies that specialty is a practice type and level_4_5_percentage is a percentage (67% vs 48%), but it does not clarify annual_claim_volume units, number format (0-1 vs 0-100), or whether inputs are required. It partially compensates for the low schema coverage but not fully.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose5/5

Does the description clearly state what the tool does and how it differs from similar tools?

The description opens with explicit use cases (OIG audit prep, RAC review, revenue integrity) and enumerates specific outputs: E/M distribution benchmarks, upcoding risk signals, OIG audit priority themes, and RAC watchlist. This goes well beyond the tool name and clearly distinguishes it from the generic get_*_benchmark family.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines4/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

Provides explicit 'Use when' guidance for three distinct compliance scenarios. It does not mention when not to use it or name a specific alternative sibling, but the stated scenarios are specific enough to guide tool selection.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.

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