An independent review of your revenue cycle and daily operations. Every issue is sized in dollars and traced to its root cause. Then the cause is fixed and written into a rule, so the same error is caught before it comes back.
Two pages, 16 questions: the numbers, payments, stuck claims and repeat problems.
If the same denial shows up every month, nobody turned it into a rule. A fix with no owner and no follow-up date isn't fixed.
One insurance company, three products, three fee schedules. If your system treats them as one, you can't trust your payer mix or tell when you're being underpaid.
Last month's cash keeps rising for weeks after month end, or there's an unapplied balance nobody owns. Money in the bank that never reached the books makes paid claims look open.
None of these is a billing-staff problem. Each is a missing structure: a rule nobody wrote down, a record set up once and inherited by every claim since, a number nobody owns. That is what a review finds, and what the Rules Engine keeps fixed.
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, written procedures get skipped and a denial follows weeks later. We build your rules into software that runs alongside the systems you already use, so the right thing happens every time. Here is how one denial becomes one rule.
Payer denies a follow-up visit: no current referral on file.
Referral expired eleven days before the visit. Nobody asked for a new one, because nothing told them to.
"Referral on file and current before any visit that needs one." Owned by the front desk, checked every morning.
A visit three weeks away shows on the worklist with the referral expiring first. Staff request it now, not after the denial.
| 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 |
Rules are written down once and owned by your practice. No sticky notes, no side spreadsheets. A new hire works the same list on day one.
Each role and office sees its own list, overdue first, with a progress count leadership can read at a glance.
Who did what, and when. Exceptions need a supervisor's sign-off, and nothing is cleared in bulk.
After every refresh the engine checks its counts against your system. If something doesn't match, it stops and says so.
No new EHR and no double entry. It reads from your existing systems, and your data stays on your practice's own computers.
The same engine checks charges, coding, modifiers, documentation and payer-specific rules before anything goes out.
Built for specialty practices and in daily use at a multi-location practice.
A practice runs on many workflows at once. Left loose, each one drifts, and the delays surface later in care, billing and communication. Each workflow below gets the same treatment: steps and owners written down, handoffs that move on their own, and exceptions on the morning worklist. Revenue is what comes out when the day runs well.
Tracked from request to the referral on file. Visits still waiting on one come up well before the patient arrives.
Fewer patients turned around at check-in.
Every order and prescription has a path from written to completed. One that stalls comes up with its next step and owner.
Care starts when it was meant to.
School medication forms, prior auths, referral letters and records requests generated from data you already hold. Staff review and sign instead of retyping.
Typing time back, and claims that go out with paperwork in place.
Follow-up visits, resupply and ongoing treatment each have a next due date. Patients who are drifting come up while a reminder still helps.
Patients stay on their plan.
Appointments showing signs of a likely no-show are flagged early, so staff can confirm, remind or offer the slot to someone else.
More visits kept, fewer empty slots.
Coverage checked ahead of each visit and again when it changes. A visit without a current check comes up before the patient arrives.
Coverage problems solved before care, not after a denial.
Open balances matched to upcoming visits, so they can be raised kindly at check-in instead of chased later.
More collected at the front desk.
If it repeats, it can be structured, watched and built for: intake, inventory, anything your practice does over and over.
Staff time back and problems caught before they cost money or care.
We count recovered dollars only when a payment arrives after a documented fix. The baseline, the scorecard and the definitions never change, so progress is real and comparable. The biggest savings come from prevention: every denial driven out is a claim that never has to be worked again.
| Measure | Baseline | Month 7 | Change |
|---|---|---|---|
| Denial rate (claim lines) | 11.2% | 4.8% | −6.4 pts |
| Rejected before the insurer | 4.6% | 1.1% | −3.5 pts |
| A/R over 90 days | 21% | 12% | −9 pts |
| Days in A/R | 47 | 34 | −13 days |
| Unexplained write-offs | $9,100/mo | $1,400/mo | −85% |
| Every figure cites its report, page and date pulled. Leadership sees totals only; claim-level detail stays on the practice's own systems. | |||
Charges, not collections, and no assumptions about what your payers allow. A review replaces these with your real numbers, each tied to its source.
The same four steps for every practice. We start read-only, with the data your systems already hold, and nothing changes in your billing system until you approve it.
Data access, an inventory of every built-in report and export, and a baseline of where things stand today.
A system-by-system review. Each issue is defined, sourced, tied to a total, checked independently, sized in dollars and traced to its root cause.
Fix each root cause once you approve it: setup corrections, intake and pre-send checks, and rules built into the worklists your team works from every day.
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.
Every service is built to drive out defects, not just report them. Leadership gets clear numbers and the decisions that need them. Your billing team gets the worklists and guides to act on them.
Find what is broken and size it in dollars.
Fix the setup every claim inherits.
Turn each denial and issue into a rule that keeps holding.
One initial package, then the same measures every month.
A set follow-up routine, with worklists that build themselves.
Choosing, moving, connecting, and building right from day one.
Totals, trends, benchmarks and decisions. Never claim-level lists.
Claim-level detail, worklists and guides, kept on the practice's own systems.
An issue is only useful if leadership can trust it. Every number we publish meets the same standard, and your patients' information never leaves your control.
Some exports stop at a fixed number of rows without saying so. "Medicare" on a record is not proof of Medicare. Clean claims and paid claims are different measures. A low payment is a question, not yet an underpayment. We check every total against its source before anyone relies on it.
Amounts are set for each practice after a short conversation about size and goals. Every engagement starts read-only, and we will ask for a business associate agreement before we handle any patient information.
Data access, report inventory, baseline, and the initial package with first issues sized in dollars.
The leadership package and monthly scorecard, with the same definitions every month.
Questions outside the package, such as a payer contract review or a new service line.
Fuller rebuilds once complete data access is in place, and the Rules Engine set up for your practice, with ongoing support as your rules change.
Tell us how your practice runs today: the workflows that slow you down, the billing that doesn't add up, and what you'd fix first. We'll come back with a clear scope and a fixed fee.
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