Revenue cycle consulting for practices
Where the revenue is leaking.
Denial patterns, audit readiness and revenue cycle red flags, read by an auditor who reviews claims from the payer's side.
The number under the number
Eight percent looks normal. Normal is expensive.
8%
First-pass denial rate for single-specialty practices. It hasn't moved since 2019.
60%
of returned claims, as many as, are never resubmitted. Work you already did, aging out.
86%
of denials are potentially avoidable. Most start at the front end, not in billing.
Sources: MGMA DataDive Practice Operations, 2023. Change Healthcare denials analysis, cited by MGMA.
What I look at
The denial letter says what was missing. I find out why.
01
Coding and documentation audits
Provider notes read against the codes billed, with findings sorted by provider.
02
Denial review and resubmission
What was denied, why it was denied, and what can still be recovered.
03
Revenue cycle audit
Front end to back end, to find where the money stops moving.
04
Billing support
Claim follow-up and payer back-and-forth, so worked denials don't age out.
Specialty focus: CLIA labs and mental health practices.
What to track instead
Three numbers your report doesn't show.
Denial resubmission rate
Of everything denied last quarter, how much was actually worked.
Preventable denial share
How much traces to registration, eligibility, documentation or coding, not a real coverage dispute.
Denials per provider
They cluster around a few documentation patterns from a few clinicians. The highest-yield audit you can run.
Pull your last 90 days of denials and sort them by provider before you sort them by payer.
Who does the work
I've read practice notes from the payer's side.
I review claims for Medicare, Medicare Advantage, Medicaid and commercial plans. The denial letter rarely says what went wrong. It says what was missing.
I bring that read to your practice, so the fix happens at the note, before the claim goes out.
Jesse Gallop · LPN, CDIP, CCS, CCS-P, CPMA, CPB, CRC, HCS-D, HCS-O
AHIMA-Approved Trainer · AAPC-Approved Instructor
Start here
Tell me about your practice.
Your inquiry comes straight to me and gets a personal reply. The more you tell me, the more useful that first reply will be.