This is what we would actually do, in what order, and what it costs.
No discovery call is required to see the number.
What we would go looking for
These are patterns that recur in healthcare, written as things to
look for. They are not findings from a named engagement.
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.
The sequence
Five weeks for one operating unit. More units run in parallel rather than in
series, so a group does not take five times as long.
Week 1
Intake and reconciliation9 requests written for healthcare, alongside the 107 covering the operating spine. We tell you which findings the gaps will limit before any fieldwork starts.
Weeks 2–3
Full pass, not a sampleEvery encounter in scope is read rather than sampled.
Week 4
Quantification and challengeEach finding sized, and put to whoever owns it before it is written down.
Week 5
Report and walkthroughThe written report, ranked by annual value and by how hard each finding is to act on.
4 core requests written for healthcare, inside the full intake.
Anything you do not have can be skipped with a reason — skipping narrows what the
review can conclude, and we tell you where before the work starts rather than after.
Claims detail — 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
Payer contracts and fee schedules — Including escalators, effective dates and termination notice.
Provider credentialing and enrollment — Time from application to first billable encounter, and where it waits.
If any of this is already happening
The review is always worth doing and rarely urgent. It becomes urgent when
something else is happening — and if one of these is, the sequence above compresses
to fit it.
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 needs to be in the room
Signs it: Practice administrator or CEO; the managing physician on clinical scope
Will resist it: Physician owners whose compensation formula the review will decompose — worth telling them what the
review is for before they hear it from somewhere else.
Has been asking for it: The revenue cycle lead, who can already name the problem sites
What it costs
Priced by operating unit — an entity, a location, or a business the accounts are
kept separately for. The second unit costs less than the first because by then the
intake is built, the chart of accounts is understood and the patterns are known.
Purchase order is the primary route — most
buyers this size raise a PO and pay against an invoice on terms. Card and bank
transfer exist for those who prefer them.