Quick note on these screenshots: the patient shown throughout this article ("Dylan Hahn") is a synthetic demo patient used for internal training purposes only. No real patient data or PHI was used to create this article.
Step 1: Review the Note
Start on the Note tab. This is where CarePilot's generated documentation lives — HPI, ROS, exam, and the rest of the note pulled from the visit recording.
Read through it the way you'd review any chart note. Edit directly in the text if something needs a tweak, or leave quick 👍/👎 feedback next to a section. There's nothing to accept or reject on this tab — it's a straight read-and-edit step.
When it looks right, click Dx + Orders → at the top of the page to move on.
Step 2: Confirm Diagnoses & Orders
The Dx + Orders tab shows the diagnoses CarePilot pulled from the chart (tagged FROM PROBLEM LIST) and any newly identified diagnoses, along with the orders and prescriptions it suggested for each one (tagged AI SUGGESTED).
Use the "Did AI Suggested Orders generate correctly?" banner to give quick 👍/👎 feedback on the order suggestions. Add, edit, or remove any diagnosis or order here — nothing is finalized until you move on.
Click Billing → when this looks right.
Step 3: Review and Accept the Billing Codes
The Billing tab recommends the actual CPT/HCPCS visit codes, with a plain-language Rationale explaining why (for example: combined preventive + problem visit, MDM vs. time, modifier 25).
Each recommended code shows:
The code and description — e.g. 99396 (Preventive Medicine) or 99214 (Office Visit, Level 4)
Method Details — whether the level was determined using Time or MDM, and the complexity
Linked Conditions — the ICD-10 codes tied to that code
A Snippet — the billing rationale text, with an Insert into A/P toggle controlling whether it's added into the note
Review each code and either Accept ✓ or Reject ✕ it individually, or use Accept all / Reject all at the top if everything looks right. The Overall status banner flips from Pending review to Accepted once every code has a decision.
Nothing is billed until you accept it here. This step is always a human decision — CarePilot recommends, you decide.
Step 4: Push to Athenahealth
Once every code is accepted and the Overall status reads Accepted, the bar at the top of the screen becomes an active Push to Athenahealth button. Click it to send the finished note — HPI, diagnoses, orders, and accepted billing codes — over to Athenahealth.
Step 5: Rate the Note's Accuracy
Right after you push, a Sent to EHR pop-up asks you to rate the note's accuracy with a quick 👍 or 👎. It takes two seconds and directly improves CarePilot's AI quality over time — worth doing on every visit, not just the ones that needed heavy correction.
Step 6: Open in athenaOne to Finish
Once the note has been sent, the button in the top bar becomes Open in Athenahealth. Click it to jump straight into Athenahealth for your final check — confirm the note, diagnoses, and codes all landed the way you expect, then close out the visit as usual.
Quick Recap
Note tab — review the generated note, then click Dx + Orders →
Dx + Orders tab — confirm diagnoses and orders, then click Billing →
Billing tab — review the rationale and Accept (or Reject) each code
Push to Athenahealth — sends the finished note to the EHR
Rate the note — 👍 or 👎 on the Sent to EHR pop-up
Open in Athenahealth — do your final review and close the visit
Getting Started
No setup needed — this flow is available on every visit as soon as your note finishes generating. New to CarePilot? Walk through this sequence once end-to-end before your first full patient day so each step feels familiar.
Questions? Reach out any time in the Help Center chat.