For medical practices of every specialty
Your practice deserves the same rigor you give your patients.
An independent revenue-cycle and operations review that drives out defects, not just finds them. We examine every system in your practice, size each finding in dollars and trace it to its root cause. Then we fix the cause and set the rules and checks once, so the same errors are caught before they come back.
What a review covers
You review every system. So do we.
A clinical review of systems checks each part of the body in order, so nothing is missed. We do the same for the business side of your practice, from the front desk to the month-end close.
Patient access & eligibility
Is the right insurance verified before care is delivered, with the right plan type on file?
Insurance & fee schedules
Do payer records, plan types and fee schedules in your billing system match how payers actually pay?
Charge capture & submission
How quickly do claims go out, and how many clear the clearinghouse on the first try?
Denials & A/R follow-up
Why payers say no, what it costs, and whether anyone is working the balance before it ages out.
Payment posting & write-offs
Is money applied to the right claims, and are write-offs controlled by a policy?
Payer rates
Are payers paying what they usually pay, and what your contracts say they should?
Services
Eight services, one accountable advisor
For medical practices of any specialty. Every service is built to drive out defects, not just report them: each problem is traced to its root cause, fixed there, and backed by a rule or check that keeps holding. Leadership gets clear numbers and the decisions that need them; your billing team gets the worklists and guides to act on them.
Discovery & baseline
Before anything is built, we learn what your systems already hold and record where things stand today.
- An inventory of every built-in report and export, and the limits of each
- Data access: exports, payer remittances, sent claim files and, where available, direct access
- Contracts and fee schedules by payer and plan, with effective dates
- Who does what in billing, and where follow-up is logged
System reconfiguration
Fix the setup that every claim inherits. One corrected record stops the same error on every claim that would have used it.
- Insurance records audited plan by plan, not company by company
- The plan type each record sends on the claim
- Fee schedules and contract terms in your billing system
- Setup checks at intake, so the error isn't keyed in again
Month-end leadership package
One monthly package in plain billing-office language, with one headline number per section and simple charts.
- Headline measures: total A/R, days in A/R, charge lag, A/R over 90 days, first-pass acceptance, denial rate
- A/R aging, A/R by payer and payer mix, high-dollar claims
- Cash collected, denials, and production by service line and provider
- Dollars at stake, actions with an owner, and decisions needed from you
Denial & rejection review
Every denial reason, with its dollars, root cause and fix. We drive out the defect behind each one, so repeat denials stop at the source instead of being rebilled one by one.
- Clearinghouse rejections kept separate from payer denials
- Denials by reason, payer and dollars, counted once per claim
- A quick guide for staff: what each top reason means, how to fix it, and how to prevent it next time
Denials and Issues Build the RulesEach denial reason becomes a rule or check in the Rules Engine.
Follow-up workflow & tracking
Work in a set order, logged the same way every time, so nothing ages without an owner.
- A daily worklist with each claim counted once, and a check that catches known defects before new claims go out
- A claims-by-payer view that points staff to the easy wins first
- Timely-filing status against each payer's own limit
- Standard follow-up task names and tracking reports
Denials and Issues Build the RulesEach issue found in follow-up becomes a rule or check, so it is caught before the next claim goes out.
A/R, payment & rate reconciliation
Checks that show whether the money in your reports is the money you actually have.
- A/R rebuilt from claim balances and reconciled to your system's report in dollars
- Cash, adjustments and A/R tied to your general ledger by month, with every gap explained
Finds money that should have arrived and didn't, or arrived and wasn't accounted for.
- Possible underpayments: payments well below that payer's usual rate for the same code and modifier, flagged and then checked against your contract
- Payments with no remittance: virtual cards, paper checks and patient payments, found and matched
- Missing or late payments: open claims with no payment, aged from the date first sent, plus claims never sent at all
- Unexplained write-offs: reviewed by type and size, with large or unusual entries explained before anything is reported
Proving revenue improvement
A baseline before any change, a monthly scorecard after, and recovered dollars counted claim by claim.
- Baseline: monthly cash, denial rate, first-pass acceptance, A/R and A/R over 90 days, write-offs, setup errors
- The same definitions every month
- Only payments that arrive after a documented fix are counted
- Tracked on the same measures each month, so you can see whether a fixed problem has come back
The Rules Engine & automation
Where defects are driven out for good. Your practice's rules are built into daily worklists that sit alongside any system in your practice, so a fix made once keeps holding. Monthly reports and worklists can refresh automatically. How it works
Denials and Issues Build the RulesIts rules come from your own denials and issues, found in the denial review and follow-up.
Practice leadership
Receives totals, trends, benchmarks and decisions. Never claim-level lists.
Billing staff
Receives the claim-level detail, worklists and guides, kept on the practice's own systems.
The Rules Engine
Set the rule once. It holds.
Every practice already has its rules: get the referral before the visit, verify benefits before the order, keep units within the payer's limit. On a busy day, rules that live in people's heads get missed, and a denial follows weeks later.
The Rules Engine works alongside any system in your practice: practice management, EHR, scheduling, billing, inventory and more. It checks your schedule, orders, charges and other data against your practice's rules and turns every exception into a daily worklist, so a problem is caught before the claim goes out, not after it comes back denied.
Denials and Issues Build the Rules.Every denial and every issue we find becomes a rule or check, so the defect is driven out instead of worked again.
Built for specialty practices and in daily use at a multi-location practice.
Today's worklist · Front desk
Sample| Item | Rule | Status |
|---|---|---|
| New patient visit, Tue 9:40 | Referral on file before the visit | Overdue |
| Medication refill order | Prior authorization still current | Due today |
| Follow-up visit, Wed 2:15 | Benefits verified within 30 days | Due today |
| Charge review | Units within the payer's limit | Done · signed |
Your rules, in one place
Referral, benefits, authorization and charge rules are written down once and owned by your practice, not hidden in someone's routine.
Worked every day
Each role and office sees its own worklist, overdue first, with a progress count leadership can read at a glance.
Every action signed
Who did what, and when. Exceptions need a supervisor's sign-off, and nothing is cleared in bulk.
Numbers that tie
After every refresh, the engine checks its counts against your system. If something doesn't match, it stops and says so instead of showing incomplete work.
Works with what you have
No new EHR and no double entry. It reads from your existing system, and your data stays on your practice's own computers.
Grows with you
New rules are added as new denials and issues surface and as payers and policies change, and every list exports to Excel exactly as it appears on screen.
Approach
Find it, fix the cause, keep it fixed
The same four steps for every practice, built to drive out defects rather than just list them. We start read-only, with the data your systems already hold, and nothing changes in your billing system until you approve it.
- 1
Discover
Data access, an inventory of every built-in report and export, and a baseline of where things stand today.
- 2
Diagnose
A system-by-system review. Each finding is defined, sourced, tied to a total, checked independently, sized in dollars and traced to its root cause.
- 3
Drive out defects
Fix each root cause once you approve it: setup corrections, intake and pre-send checks, and rules built into the worklists, denial guide and follow-up routine your team works from every day.
- 4
Report & prove
The month-end package and scorecard on the same definitions every month, so you can see that fixes hold. Recovered dollars are counted only after a documented fix.
Discovery checklist
What we look at first
- Every report your systems already offer, before building anything new.
- How data can be reached: direct access, built-in reports or exports, and the row limits of each, so nothing is quietly cut off.
- Payer remittances (835s) for payment and denial truth, and the claim files that actually went out.
- Payments with no remittance: virtual cards, paper checks and patient payments.
- Contracts and fee schedules by payer and plan, with effective dates.
- Who does what in billing today, and where follow-up is logged.
Standards
Clinical rigor for the business of medicine
A finding is only useful if leadership can trust it. Every number we publish meets the same standard, and your patients' information never leaves your control.
Every number earns its place
- A definition in plain words.
- Its source: the system, report and date pulled.
- A tie to its parent total.
- An independent check before it reaches you.
Patient data stays protected
- Patient-level data stays on one designated, secured machine.
- Shared reports carry totals only: counts, dollars and rates.
- Systems are reviewed read-only; nothing changes without approval.
- Files in transit are verified and securely deleted.
Results we can prove
We count recovered dollars only when a payment arrives after a documented fix, claim by claim.
The baseline, scorecard and definitions stay the same every month, so progress is real and comparable.
What we look for
Common findings in practice billing
Lessons built into every review we run. Each one can hide money in plain sight.
"Medicare" on an insurance record is not proof of Medicare.
Commercial carriers also sell Medicare Advantage and Medicaid plans. When one record covers several products, claims can go out with the wrong plan type. We audit per plan, not per company.
The system's A/R report may not be your real A/R.
Outstanding-balance reports can book expected payments up front or apply filters you can't see. We rebuild A/R from claim balances, show credits on their own line and reconcile in dollars.
Remittances alone understate cash.
Virtual-card and paper payments have no 835 on file. We reconcile cash to the general ledger by month and explain every gap.
Clean claims and paid claims are different measures.
Clearing the clearinghouse is not the same as being paid by the payer, so a high acceptance rate can sit alongside a high denial rate. We measure both and keep one definition for each.
There is no single filing deadline.
Each payer sets its own limit, and your contracts can override the published one. We check every unfiled claim against that payer's own limit, so the most urgent claims are worked first.
A low payment is a question, not yet an underpayment.
We compare each payment with that payer's usual rate for the same code, then check it against your contract before calling anything short.
Reports can be quietly incomplete.
Some exports stop at a fixed number of rows without saying so. A total that lands on a round number is a warning sign. We check every total against its source before anyone relies on it.
Engagements
How engagements are structured
Clear scope, clear fees. Amounts are set for each practice after a short conversation about size and goals.
Discovery & diagnostic
Data access, report inventory, baseline and first findings, sized in dollars.
Reporting & scorecard
The leadership package and monthly scorecard, with the same definitions every month.
New analysis
Questions outside the package, such as a payer contract review or a new service line.
Rebuilds & Rules Engine
Fuller rebuilds once complete data access is in place, and the Rules Engine set up for your practice and systems, with ongoing support as your rules change. Scope and structure are set case by case.
Every engagement starts read-only. We will ask for a business associate agreement before we handle any patient information.