Every practice starts with a baseline of queues, denial reasons, and days in A/R. The monthly review uses the same definitions so the practice can see what moved.
Published examples follow this structure and use figures the practice has approved for the site.
1. Situation
Specialty, sites, systems, and the queue the practice can already name.
2. Workflow
How eligibility, coding, submission, posting, and follow-up actually move today.
3. Measures baselined
Definitions for acceptance, denial mix, days in A/R, and the collection ratio in use.
4. What a proposal would include
Tasks, access, safeguards, and the reports the monthly review will show.
5. Results
Figures published on this site come from the practice’s approved reports and use the same definitions as the monthly review.
Illustration, not a client
Illustrative primary care access problem
A fictional three-clinician primary care office bills from an EHR it already owns. Eligibility is checked when the front desk has time. Denials for inactive coverage are worked as appeals.
What share of denials are eligibility reasons, by count rather than dollars?
Is the 271 response stored, or only a copay amount?
Which visits were never charged because the note stayed unsigned?
Baseline denial mix, charge lag, and the share of statements sent before adjudication. No target percentage is assigned in the illustration.
Illustration, not a client
Illustrative orthopedic authorization problem
A fictional orthopedic group authorizes some surgeries and discovers others at denial. Postoperative visits are sometimes billed inside a global period.
Does the authorization name the procedure that the operative note describes?
How are global-period visits identified before coding?
Are professional and facility estimates separated for the patient?
Baseline authorization-related denials and global-period E/M denials separately. The illustration does not estimate recoverable cash.
