Find the revenue your claims are leaving behind
Our certified auditors test coding, documentation and payment against payer rules, then show you exactly where collections leak and what it takes to stop it.
Assumes 65% of denied claims are never resubmitted and a post-audit denial rate of 5%. Your audit replaces these assumptions with your own claim data.
Every code tested against the note and the payer rule
We pull a statistically valid sample of claims and review each line against the source documentation, the CPT and HCPCS code set, and the payer's edits. Findings are scored by dollar impact and compliance risk.
CPT/HCPCS unbundling
Component codes billed separately when a comprehensive code applies, checked against NCCI procedure-to-procedure pairs and MUE limits.
Upcoding and undercoding
Levels that the documented MDM or time does not support create refund liability. Levels below what was documented leave earned revenue unbilled.
ICD-10-CM specificity
Laterality, episode-of-care 7th characters and combination codes. Unspecified diagnoses are a leading trigger for medical-necessity denials.
Medical necessity matching
Diagnosis-to-procedure pairing verified against the applicable LCD or NCD covered-code list and frequency limits.
From gross charges to cash, with every loss accounted for
Contractual adjustments are expected. Adjustments that exceed your contract are not. We reprice paid claims against your loaded fee schedules to separate the two.
Contractual allowance auditing
Each allowed amount compared line by line to the contracted rate for that CPT, modifier and place of service.
Fee schedule variance
Payers that have not loaded annual escalators or are still paying an expired schedule.
Silent PPO discounts
Rented-network discounts applied without a direct agreement, identified through remittance network codes.
CCI edits and ABN compliance
Denials from avoidable CCI conflicts, and non-covered services billed without a valid ABN and GA modifier, which cannot be billed to the patient.
Old A/R is a symptom. We trace it to the workflow that caused it
Open balances are classified by age and payer, then every denial is mapped to the stage where it originated. Fixing the source is what keeps the same CARC codes from returning next month.
See where each provider sits on the curve before a payer does
We chart every provider's distribution across 99202–99205 and 99211–99215 against CMS specialty utilization. Outliers at Level 4 and 5 are the pattern payer analytics and RAC contractors look for first.
MDM complexity review
Problems addressed, data reviewed and risk of management scored against the AMA MDM table for each sampled visit.
Time-based coding
Total time on the date of service documented and attributable, including prolonged service add-on eligibility.
Provider scorecards
Accuracy rate, dollar variance and specific documentation gaps, delivered per provider for focused education.
An executive RCM dashboard built on five numbers that matter
Every client report opens with the same KPI suite, measured the same way each month, with targets set against MGMA and HFMA benchmark ranges. Select a metric to see its trend.
Share of claims paid in full on the first submission, without rework, appeal or resubmission. The clearest single measure of front- and mid-end quality.
Reports that speak your specialty's billing rules
Generic reports miss the rules that drive specialty revenue: global surgical periods, component billing, therapy thresholds, frequency limits. We build them in.
Know which contracts pay, and which ones only look like they do
Payment speed, denial frequency, appeal yield and effective yield per RVU, reported by payer so renegotiation starts from evidence.
Start with a free billing audit
Send a recent A/R aging report and 90 days of remittance data. We will return a findings summary with dollar impact, top denial root causes and a sample of the reporting you would receive monthly.