Revenue leakage rarely shows up as one big problem. It is the visit that was completed but never charged, the claim rejected at the clearinghouse and never resubmitted, the underpayment posted as paid in full, the authorization that expired mid-treatment. Each is small. Together they are often several percent of what a practice should collect.
The Revelrex RCM audit follows the money from the appointment book to the bank deposit and shows you, with your own numbers, where it stops. You receive a findings report and a prioritized list of fixes, whether or not you ask us to implement them.
Practices that benefit
- Practices that suspect leakage but cannot point to it.
- Owners evaluating an in-house billing team or an outside vendor.
- Groups preparing to change billing systems or vendors and wanting a baseline.
- Practices with AR over 90 days above roughly 20% of total AR.
What usually goes wrong
Completed encounters with no claim
Schedule says the patient was seen; the billing system has no charge. Nobody reconciles the two.
Rejections that age out
Clearinghouse rejections left unworked until timely filing passes.
Denials with a pattern
The same payer, the same code, the same reason, month after month.
Posting that hides underpayment
Contractual adjustments taken without checking the contract; balances written off instead of appealed.
Bottlenecks nobody measures
Charges entered a week after the visit; claims held for provider signature; statements sent quarterly.
The actual work
RCM workflow review
We interview the people who do the work and map the actual process from scheduling to payment posting, including hand-offs and systems.
Encounter-to-claim reconciliation
Appointments and completed encounters for the audit period are matched against charges and claims. Unmatched encounters are listed by provider and date.
Unbilled encounter identification
Encounters with no charge, charges with no claim, and claims never accepted by a payer.
Coding backlog analysis
Age of uncoded and unsigned encounters and the reasons they wait.
Claim submission gaps
Lag between date of service and claim submission by provider and payer; claims near or past timely filing.
Rejection and denial patterns
Clearinghouse rejections and payer denials by reason, payer, provider and code, with the preventable share estimated.
Payment and posting review
A sample of remittances checked against contracts for underpayments, incorrect adjustments and unposted payments.
AR observations
Aging by payer and balance type; credit balances; patient balances never statemented.
Revenue leakage opportunities and bottlenecks
Each finding is quantified where the data allows and tied to the step in the process that caused it.
Practice-action dependencies
Findings that depend on the practice (front desk, providers, contracts) are separated from findings a billing team can fix alone.
What is included
- Standard scope: one legal entity, up to five providers, the most recent 90 days of encounters and claims plus current AR.
- Workflow interviews with billing, front desk and one provider.
- Findings report with quantified leakage estimates and prioritized recommendations.
- A one-hour review call to walk through the findings.
Not included
- Remediation: correcting claims, appealing denials, or reworking AR found during the audit (available as follow-on services).
- Payer contract negotiation.
- Legal or compliance opinions.
- Remediation work, appeals of denials found during the audit, and legal or compliance opinions are outside the audit and can be scoped as follow-on services.
What your practice needs to provide
- Read access to the practice management system, EMR and clearinghouse, or data exports for the audit period.
- Payer contracts and fee schedules where available.
- Thirty to sixty minutes with each of the people interviewed.
Step by step
- 1
Kickoff
Agree the scope, period and access. Usually one call.
- 2
Data and interviews
Reports pulled, exports received, interviews scheduled within the first week.
- 3
Analysis
Reconciliation, pattern analysis and posting review.
- 4
Findings
Written report delivered, typically within three weeks of receiving access.
- 5
Review
Findings call with your team and a recommended order of fixes.
What you receive
Findings report: unbilled encounters, submission lag, rejection and denial analysis, posting findings, AR observations.
Quantified leakage estimate by category.
Prioritized recommendations, separated into practice actions and billing-team actions.
Appendix of the underlying lists (unbilled encounters, denied claims by reason) for your team to act on.
Add RCM Audit to your Service Cart
A written proposal follows within two business days.
Frequently asked
What should an RCM audit actually evaluate?
Whether every encounter became a claim, whether every claim reached the payer, whether every payment matched the contract, and how long each step took. Anything less is a report about your billing system, not about your revenue.
How much leakage do practices typically find?
It varies widely. Practices with an unreconciled charge process often find unbilled encounters worth 1% to 3% of charges. Denial and underpayment findings add to that. Your report shows your own numbers, not an industry average.
Will this disrupt our billing team?
The audit uses reports, exports and a few short interviews. Daily work continues. Many billing teams welcome it because it documents the problems they have been reporting.
Do we have to use Revelrex for billing afterwards?
No. The findings are yours. Some practices fix the issues internally, some hire us for specific items, some move billing to Revelrex. The audit is priced so it stands on its own.
How current does the data need to be?
The standard scope uses the most recent 90 days so the findings reflect the current process, plus a full AR snapshot.