Reporting, Analytics & RCM Consulting
Make performance objective and visible—clean definitions, denial root-cause analysis, and evidence-linked dashboards that drive action across your revenue cycle.
When to Use This
- Leaders see different numbers for the same KPI (definition drift)
- You need clean-claim, denial, and AR views by payer, clinic, and provider
- Appeals and rework aren’t tied back to root causes or coding feedback
- Coverage windows and queues aren’t forecasted—backlog surprises happen
- You want a pilot plan with clear success criteria before scaling changes
Typical Deliverables
- KPI dictionary with exact formulas (CCR, DNFB, DSO, AR aging, FPY, Rework%)
- Denial analytics: root-cause model by payer/denial class/provider with Pareto
- Evidence-linked dashboards (tiles to claims, notes, EOB/ERA, policy cites)
- Operational views: backlog aging, cycle times (p50/p90), forecast vs. actual
- QA program: defect classes, AQL targets, calibration cadence, drift checks
- Pilot blueprint: sample sizes, gates, and rollback criteria
Format
Diagnostic Sprint (1–2 weeks)
- Artifact review, workshops, and shadowing of RCM lanes
- Outputs: KPI dictionary, denial Pareto, dashboard spec, QA plan
- Best when definitions and visibility need alignment before change
Format
Pilot Blueprint (2–4 weeks)
- Test design with sample sizes and acceptance thresholds
- Outputs: metric wiring, evidence tiles, change-control plan
- Leads directly into a short pilot on selected lanes
Format
Controls Tune-Up (targeted)
- One lane (e.g., Charge Entry, Denials, AR follow-up) tuned for QA/SLAs
- Outputs: revised SOPs, QA checklist, training & calibration plan
Example Engagements
Sample
Clean-Claim Lift for Multi-Specialty Clinic
- Unified KPI dictionary (CCR, submit TAT) across coding and charge entry
- Pre-submit edits added; rejection worklists cut 32% within two cycles
Sample
Denial Prevention & Appeals Win-Rate
- Root-cause model by payer & denial class; preventable vs. payer-error split
- Appeals templates w/ policy cites; overturn rate +18% quarter over quarter
Sample
AR Aging & Underpayment Detection
- 30/60/90+ views by payer, specialty, and rendering provider
- Underpayment flags tied to contracts; recovery workflow & tracking
Sample
Coverage & Backlog Forecasting
- Shift grids sized to forecast error; surge buffers for month-end & seasonality
- Backlog burndown dashboards with recovery windows
FAQs
Why start with Reporting & Analytics?
Shared definitions and evidence-linked views remove ambiguity, so quality, staffing, and outcomes decisions become objective and fast.
Can you run the pilot you design?
Yes. We often operate the pilot with Carenox pods or embed QA/controls while your team runs production.
How are fees structured?
Fixed fee by scope. If we continue into delivery, we can credit part of the fee into the pilot.
We already track KPIs—what changes?
We align definitions, wire evidence tiles, and add QA/calibration to reduce drift and make numbers audit-ready.
Next Step
Start with a 1–2 week Diagnostic Sprint or go straight to a Pilot Blueprint if scope is already defined.
