Denied once, and then never touched again.

“The denial rate looks fine. So why is cash down?”

Revenue cycle is measured in aggregate and lost in specifics — a payer, a reason code, a queue. Reading it end to end rather than by sample finds the concentrations that averages hide.

revenue cycle
denials
reason code
underpayment
charge master
credentialing
case mix
preference items

Your words, not ours.

Where it concentrates here

Five places the money tends to go in healthcare. Each one is concentrated — a single agreement, a single queue, a single account nobody reviews — which is why sampling walks straight past them.

Denials by reason code and payer showing one or two causes carrying most of the value, with no owner assigned to either.
Denied claims never reworked at all, because the queue exceeded the team's capacity and the oldest simply aged out.
Contracted rate against paid rate never systematically compared, so underpayment is invisible unless a payer volunteers it.
Credentialing and enrollment adding weeks between a clinician's start date and their first billable encounter.
Preference-item supply variation between clinicians doing the same procedure, with no clinical difference in outcome.

Not every healthcare is the same business

Multi-site physician groupsPayer contracts negotiated per location or inherited through acquisition, so the same CPT code is reimbursed differently across the group.
Dermatology, ophthalmology and specialtyAncillary revenue — pathology, cosmetics, optical — with materially different margins that are rarely reported separately.Read the page for dermatology, ophthalmology and specialty →
Dental groups and DSOsPer-location P&Ls where doctor compensation formulas differ by acquisition vintage and nobody has modeled the aggregate.Read the page for dental groups and dsos →
Behavioral and human servicesMedicaid and grant funding with cost-reporting obligations, where an unallowable cost found late is repayable.
Imaging, surgery centers and ancillaryCapital-heavy, utilization-driven, and priced on assumptions set when the equipment was bought.Read the page for imaging, surgery centers and ancillary →

Where this data actually lives

Epic in the larger groups; athenahealth, eClinicalWorks or NextGen in the mid-market; Modernizing Medicine in specialty practices
Waystar, Availity or Change Healthcare sitting between the practice and the payer
A separate credentialling tracker, very often a spreadsheet
Dentrix or Open Dental in dental groups, per location and rarely consolidated

Named because it changes what the intake asks for. An extract from one of these has known gaps, and the review is built around them rather than surprised by them.

Reported in your numbers, not ours

days in AR
denial rate
net collection rate
RVU per provider
no-show rate
payer mix
cost per encounter
chair or room utilization

The obligations that set the deadlines

Payer credentialling and revalidation per provider per payer — lapse and the claims deny
Medicare cost reports and Medicaid cost settlement where applicable
HIPAA security risk analysis, which is required annually and often is not done
Stark and Anti-Kickback exposure on any physician compensation formula
340B compliance where the group participates

What the review would ask you for

9 requests written for healthcare and asked of nobody else — 4 of them core. They sit alongside the operating spine every business has — finance, revenue, receivables, payables, contracts, people, IT, operations, risk, commercial and governance — which is 107 further requests.

Claims detail Core Line level for the period. De-identified wherever possible — read the personal data note before uploading anything patient-identifiable.
Denials by reason code, payer and month Core
Payer contracts and fee schedules Core Including escalators, effective dates and termination notice.
Contracted rate versus paid If variance is tracked.
Coding and clinical documentation Who codes, audit results, any coding vendor and their contract.
Charge description master Current, with last review date.
Provider credentialing and enrollment Core Time from application to first billable encounter, and where it waits.
Utilization and case mix By service line and site.
Clinical supply and implant spend With preference-item variation by clinician.

Anything you do not have can be skipped in one click, with a reason. The intake is completed in the client portal, which saves each answer as it is given and can be returned to as often as you like.

When this stops being interesting and becomes urgent

A private equity approach or a DSO/MSO roll-up
A payer contract coming up for renegotiation without a rate analysis to argue from
A denial rate that moved and nobody can say why
An acquisition where the acquired site's economics turn out to be different
A HIPAA risk analysis requested by a payer, a lender or a buyer

Who this involves

Signs it: Practice administrator or CEO; the managing physician on clinical scope
Resists it: Physician owners whose compensation formula the review will decompose
Has been asking for it: The revenue cycle lead, who can already name the problem sites

Who commissions it

CFOs, revenue cycle directors and COOs. Phase one is priced before phase two is discussed, the report is yours either way, and we take no vendor commissions or referral fees on anything we recommend.

See the proposal and the price Talk it through first

The proposal sets out the sequence week by week, what we would need from you, and what it costs for your number of operating units. No call required to see the number.

Closest to this

Operations that share more with healthcare than the sector label suggests.