Revenue Advisory
Clarity first: KPI blueprints, QA & coverage design, and evidence-linked dashboards — then a pilot that proves lift in clean claims, denials, and cash.
When to Use Revenue Advisory
- Clean-claim rate is below target; payer edits and rejections create rework
- DSO trending up; AR aging and underpayments not visible by payer/class
- Denial categories lack root-cause ownership and feedback loops
- Coverage windows and handoffs cause TAT misses and backlogs
- Stakeholders disagree on success; you need objective KPIs and gates
Typical Deliverables
- RCM KPI Blueprint: CCR, TATs, FPY/Rework, Denial mix & Overturn %
- Defect taxonomy and AQL targets with calibration cadence
- Coverage model: shifts, surge buffers sized to forecast error
- Evidence tiles: link artifacts (eligibility, edits, EOBs) to checks
- Pilot plan: scope, sample sizes, success thresholds, rollback criteria
- Commercial options: staffed pods, full-service billing, or hybrid QA
Format
Diagnostic Sprint (1–2 weeks)
- Data snapshot (payer mix, denials, AR buckets) + workflow mapping
- Outputs: KPI blueprint, defect classes, coverage math, dashboard spec
- Recommended before you commit to staffing or outcomes
Format
Pilot Blueprint (2–4 weeks)
- Test design with sample sizes and acceptance gates
- Outputs: SOP/playbook updates, evidence tiles, change control
- Leads straight into a managed or staffed pilot
Format
Controls Tune-Up (targeted)
- Focus lane (e.g., charge entry, AR follow-up, refunds, credentialing)
- Outputs: revised SOPs, QA checklist, training plan & ramp
KPIs We Blueprint
- Clean Claim Rate (first-pass acceptance)
- Submission TAT (charge entry → payer submit)
- Clearinghouse Rejection Rate & rework TAT
- Denial Rate & Overturn % by class/payer
- Days in AR (DSO) and Net Collection %
- Underpayment detection & recovery yield
Example Engagements
Sample
Clean-Claim Lift (Multi-Specialty)
- Defect classes for eligibility, coding, and payer edits
- CCR +6.8 pts; rework TAT down 41% in 8 weeks
Sample
Denial Reduction (Radiology)
- Medical necessity & modifier playbooks with AQL QA
- Overturns +22% and write-offs down after 2 quarters
Sample
AR Recovery (Urgent Care)
- Underpayment flags and appeal workflows by payer
- Net collection +3.9 pts; 90+ aging reduced 28%
What Happens After Advisory
Most clients proceed to a 2–4 week pilot. We can staff your lanes, run QA/controls, or operate end-to-end with SLAs.
Ready to Start?
We’ll review your KPIs and denials snapshot, then propose a Diagnostic Sprint with timelines and outcomes.
