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Pillar ii · Revenue Cycle, UR & Documentation
ii

The dollars side of the case file — quantified, defensible, recovered.

Billing · denials · audit-grade documentation

Revenue cycle is where dollars live or leave. We work the billing function, claims integrity, denial management, and account recovery the same way we work the evidence: sourced, documented, and stood behind. Whether you’re standing up a new RCM function, recovering from coding issues, or fighting denials at scale, the methodology is the same — and the documentation behind every dollar is built to hold under review.

Sub-services within this hub
  1. Revenue billing — claims preparation, coding accuracy, charge capture, submission discipline.
  2. Claims integrity & coding — chart-to-claim review, modifier accuracy, audit-ready documentation.
  3. Denial management & appeals — working denials at the volume and rigor the case requires.
  4. Account recovery & collections — patient AR, payer AR, takeback responses.
  5. PDGM & MDS reimbursement — prospective payment system optimization for home health, hospice, SNF.
  6. Prior authorization — process design and operational support.
  7. Revenue analytics & forecasting — cash flow modeling, payer mix analysis, dollars-at-risk reporting.
  8. Payer contract review — reimbursement rate analysis, contract performance.

The engagement

What you receive

What changes when we work the case:

  • Denial volume reduction at the pattern level. Upstream documentation, authorization, and charge-capture patterns fixed.
  • Recovery rate plus upstream pattern fix. Same denials stop coming back; recovery rate rises.
  • Coding accuracy that holds under contractor review. CDI program designed to survive UPIC methodology.
  • Reimbursement gains at contract renewal. Benchmarking, denial pattern analysis, and contract strategy producing measurable rate improvement.
  • Audit-defensible billing operations. Documentation, modifier accuracy, and medical necessity built to hold.

Regulatory context

The rules this work is built to.

The FY2025 CERT cycle put Medicare fee-for-service improper payments at $28.83 billion — a 6.55% rate — with insufficient documentation the leading driver. RAC document-request limits are tiered to a provider’s denial rate, which means a weak quarter raises the review ceiling for the next one.

Payment rules are tightening in parallel: home health took a net −1.3% in CY2026 while OASIS-E1 expanded the auditable surface, and the FY2026 SNF rule remapped 34 PDPM ICD-10 codes. Margin is falling exactly as documentation demands rise — the revenue cycle and the audit posture are now the same discipline.

Questions

From the case file.

How do you handle an active RAC or UPIC audit?

Case file open within 48 hours. Chart-by-chart response build, statistical sampling rationale documented, response packet exhibit-ready. We work alongside in-house billing or RCM vendors.

Can you support a vendor transition without disrupting cash flow?

Yes. We work alongside both vendors during transition, audit the data carryover, and ensure denial recovery and AR work continues without lapse.

What does this cost?

Denial pattern work scoped to volume. Audit defense scoped to ADR count. Scoping memo in week one before any meaningful commitment.

Do you work with PDPM, PDGM, and MDS coding teams?

Yes. Reimbursement-methodology depth is a core capability. We work alongside MDS coordinators, OASIS reviewers, and case-mix coders.

How quickly can you start?

Standard intake within five business days. Active audits within 48 hours.

Related provider types

Who we do this work for.

Home Health

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Nursing Facilities

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Hospitals

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Hospice

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Physician Practices

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When the matter is consequential

We work the case the same way.

30 minutes. No pitch. We open the case file together — and recommend the next step.

Book a 30-min discovery callExplore our four audiences