See exactly what a Revenue Cycle Health Check uncovers — the five leakage areas and the process we use to find them — before you request yours.
Rejections, denials, filing issues and payer-specific problems stall reimbursement long after the visit is over. Most practices never see the pattern — only the backlog.
Every leakage area follows the same path from discovery to a fixed process. Claims Leakage is where it becomes most visible — a rejected claim is a symptom, not the problem. The real question is always the same: what upstream process let it happen, and will it happen again next week?
Don't just manage the billing. Understand the revenue.
— Blue Bird MedservThe Health Check is a structured first look at where a practice's revenue cycle leaks. It maps findings across the five leakage areas shown above: front-end, clinical-to-billing, claims, AR and process. It is a diagnostic, not a billing takeover and not a sales presentation. Its purpose is to answer four questions for each leak: what is wrong, why it is happening, where money is being lost, and what should be fixed first.
It does not replace a deeper financial review. The Practice Revenue Cycle Audit goes further into scorecard, trend, benchmark, denial and write-off data, and the RCM Audit describes the full independent assessment and its report.
The guide above shows four of the stages. Here is what a complete engagement involves in practical terms:
| Area | What the check examines | Typical data used | Red flag |
|---|---|---|---|
| Front-end | Eligibility and benefits checks, authorization, patient information accuracy | 271 responses, authorization log, registration data | CO-27, CO-22, CO-109 and CO-197 denials; unexpected patient balances |
| Clinical-to-billing | Charge capture, coding accuracy, documentation support | Schedule, encounter list, charges, notes sample | Encounters with no charge; E/M level skew; CO-50 denials |
| Claims | Clean claim rate, rejections, denials, timely filing, payer rules | 837 files, 999 and 277CA reports, 835 remittances | CO-16, CO-18 and CO-29 patterns; rejection backlog |
| AR | Aging, follow-up cadence, underpayments, write-offs | AR aging, payment and adjustment detail, fee schedules | Growing 90+ day share; repeating underpayment on a CPT |
| Process | Manual work, ownership, handoffs, reporting | Workflow descriptions, staff roles | Unowned work queues; repeated manual checks |
You do not need to have everything. Tell us what is available, and the Health Check can start with what your systems export. Sharing protected health information should happen only under a HIPAA Business Associate Agreement and be limited to the minimum necessary.
| Result | Healthy | Needs attention |
|---|---|---|
| Front-end | Eligibility run on nearly every visit; few authorization denials | Eligibility checked only when a problem is suspected |
| Clinical-to-billing | Daily encounter-to-charge reconciliation; stable E/M mix | Open encounters at month-end; charges entered late |
| Claims | Rejections worked daily; denials concentrated in non-preventable causes | Same preventable denial repeating month after month |
| AR | Most dollars in younger buckets; underpayments checked | Dollars drifting into 90+ days; no payer variance check |
| Process | Each queue has an owner and a turnaround target | Work depends on individuals; reports built by hand |
A Health Check result is a starting map. The findings with the closest filing or appeal deadlines are handled first, and the rest are sequenced by dollars and effort.
Illustrative only. This is a hypothetical summary, not a client result. Real reports use your data and your dollar figures.
| Area | Hypothetical finding | Root cause | Priority |
|---|---|---|---|
| Front-end | Authorization denials cluster on one payer | No check at scheduling | High |
| Clinical-to-billing | Completed visits with no charge | Encounter forms not routed to billing | Medium |
| Claims | Rejections aging in the clearinghouse queue | No daily worklist owner | High |
| AR | Repeating underpayment on one E/M code | Outdated fee schedule at payer; no variance check | Medium |
| Process | Claim status checked manually, one claim at a time | No automation of status checks | Low |
| Engagement | Best for | Focus |
|---|---|---|
| Revenue Cycle Health Check | A first look at where revenue leaks | Five leakage areas, root causes, priorities |
| Practice Revenue Cycle Audit | Practices wanting financial depth | Scorecard, trends, benchmarks, AR, denials, write-offs, appeals, SWOT |
| RCM Audit | A full independent assessment before any vendor decision | Eligibility through payment posting, with the Revenue Cycle Health Report |
The Health Check is designed as the starting point. The deeper audits are the natural next step when it reveals areas worth quantifying.
Across the five areas, the same handful of root causes explain most findings. Knowing them helps you judge whether a Health Check result is a process problem you can fix yourself.
You receive a written summary of findings by area, each with a root cause, a dollar impact, a recommended fix and a priority. Items with closing recovery windows are flagged first. From there the options are open: your team can implement the fixes, you can ask for a deeper Practice Revenue Cycle Audit, or you can discuss Revenue Cycle Optimization or managed services where they make sense. Re-running the same KPIs with the same definitions later shows whether the changes worked.
It depends mainly on how quickly your data can be exported. The analysis starts once complete data is available, and a walkthrough conversation reviews the findings with you.
No. Some findings are process fixes your own team can make. The Health Check is designed to tell you what you actually need, which may or may not be a new vendor.
It is offered free of charge as an introduction to the work. You keep the findings whatever you decide to do next.
No. This page is a preview of the Health Check guide. The sections below it add practical detail on method, data and how to read results.