Every engagement bridges the gaps between clinical, operations, technology, and billing to ensure every encounter is captured, every claim is defensible, and every dollar is realized.
Full revenue cycle transformation using Lean methodology - from front-end intake and eligibility through coding and charge capture to claims, denials, and collections. Fractional RCM leadership that builds a data-driven culture and aligns every layer of the organization around financial health.
We don't hand over a report and walk away. We manage the change from the C-suite to the front-line staff - ensuring leadership, managers, billers, and clinicians are all moving in the same direction.
Billing rule architecture, service code configuration, and provider enrollment. We dive into the technical core of the EHR to find where services were provided but never billed.
Unbilled Revenue Discovery - finding the leakage hidden in system logic, misconfigurations, and gaps no one knew to look for.
PPS and BHASO encounter file builds, gap analysis, and submission validation. High-stakes BHA/HCPF compliance and contract protection.
Predictive Reconciliation - we build internal logic to estimate encounters and validate against RAE files before payer data arrives. When the numbers don't match, we have the data and confidence to push back.
Chart audits, payer-defensible documentation training, OIG prep, and Medicaid reconciliation.
We sync the medical record and the claim so your organization is bulletproof for audits.
Purpose-built training modules for behavioral health billing teams - covering coding, compliance, documentation, and payer-specific workflows. On-demand access, built-in assessments, and a curriculum designed by practitioners who've worked the claims themselves.
Not a library of generic webinars. Every module is built from real-world behavioral health scenarios by the same team that recovered millions in lost revenue. Your staff trains on the exact situations they'll face at their desks.
Design and build revenue cycle dashboards and reporting infrastructure that give every level of your organization - from billing staff to the CFO - real-time visibility into financial performance, denial trends, and revenue cycle health.
Built by the same team that used data to uncover millions in unreported revenue. We don't just visualize data - we know which numbers actually matter and what action to take when they move.
Rare, specialized skills in the systems and processes that behavioral health organizations depend on.
Deep configuration expertise in Netsmart's myAvatarNX EHR - billing rule architecture, service code configuration, and provider enrollment. We've optimized billing rule tables from millions of rows to thousands, eliminating failed weekend imports and enabling clean claim submission at scale.
Prospective Payment System (PPS) billing model built in myAvatarNX from the ground up. A model that few Colorado behavioral health centers have been able to replicate, handling the full complexity of BHA capitated payment structures.
Complete state reporting system rebuilds, BHASO encounter file construction, and predictive reconciliation against RAE data. We build internal logic to validate encounter volumes before payer data arrives, giving you the confidence to defend your numbers.
We build the visibility infrastructure and run the operational fix in parallel - not in sequence.
We define which metrics matter, build extraction from your EHR and clearinghouse, and present the story your numbers tell. AR aging by financial class, denial categorization by root cause, adjustment tracking with custom posting codes. You cannot fix what you cannot see.
Replace ad-hoc AR follow-up with prioritized, skill-based worklists. We design claim routing rules by payer, aging, and dollar value, build denial decision trees, and train your team on structured execution with productivity dashboards and QA oversight.
We segment denials by category - eligibility, billing/coding, authorization, timely filing - and trace each to its source. In one engagement, the majority of aged AR concentration traced to two payers with system bugs, not operational failure. That distinction changes the response entirely.
