Practice RCM Assessment

What is Practice RCM Assessment?

A Practice Revenue Cycle Management (RCM) Assessment is a comprehensive evaluation of a healthcare practice’s billing and revenue operations. This review analyzes revenue cycle data to measure performance, uncover bottlenecks, and enhance financial outcomes. It includes a full medical billing KPI analysis, historical benchmarking, and actionable operational insights.

38-Point Medical Billing Assessment Overview

At the core of our RCM evaluation is the 38-Point Medical Billing Assessment—a strategic and comprehensive diagnostic tool designed to uncover revenue leakage, operational inefficiencies, and compliance gaps across a healthcare practice’s revenue cycle. Each of the 38 checkpoints represents a key financial and operational area that directly impacts cash flow, claim performance, and overall fiscal health.

This assessment provides a data-driven roadmap to improve collections, reduce denials, increase billing accuracy, and drive long-term revenue cycle success.

Get a closer look at what a full Practice RCM Assessment entails 👉

Key Area of Review Includes:

Charges & Claims analysis

  1. Pending charges report to identify unbilled or missing claims
  2. Complete charge capture analysis
  3. Claim submission accuracy review
  4. Delayed charge submission analysis
  5. Claim batch transmission analysis 

Payment & Reimbursement

  1. Payment posting accuracy and payer reimbursement
  2. Underpaid and negative claims analysis
  3. Insurance payment accuracy and payer performance review
  4. Paid-to-practice address verification
  5. Medical billing fee schedule review and payer rate compliance
  6. ERA and EFT enrollment/activation status

Financial Trends & Benchmarks

  1. Three-year charge and payment comparison
  2. Provider-level revenue trends over 3 years
  3. Average charges/payments trend analysis
  4. Monthly charge/payment tracking
  5. Charges and payments segmented by billing facility
  6. Collection percentage trends over 3 years
  7. CPT code utilization and payment benchmarking
  8. Payer mix graphical summary
  9. Contractual and non-contractual adjustment analysis

Denials & Rejection Management

  1. Claim rejection trend and root cause analysis
  2. Denial management performance assessment 
  3. Denial report by payer and reason code
  4. Identifying missed payer follow-ups

Accounts Receivable (A/R) analysis

  1. AR aging report segmented by payer and insurance type
  2. Comparison of primary vs. secondary AR balances
  3. Return-to-sender (RTS) statement tracking and resolution

Patient Billing & Communication

  1. Patient statement process audit (accuracy and timeliness)
  2. Statement error tracking (incorrect balances/timing)
  3. Patient AR aging report
  4. Credit and negative balance audit and reconciliation
  5. Verify e-statement and e-payment setup
  6.  Patient credit balance detail

Operational Integrity

  1. Active provider and facility list verification
  2. Progress note audit (unsigned, undated, incomplete notes)
  3. Monthly patient visit volume review
  4. Verify the active facility list
  5. Highlight trends in repeated issues and suggest underlying causes

This assessment goes far beyond standard metrics. It thoroughly analyzes historical data, provider-specific trends, payer behavior, unbilled services, and denied or delayed claims offering a complete picture of where the practice is excelling and where vulnerabilities exist.

Ultimately, this 38-point report equips your practice with the clarity and strategic insight needed to drive immediate financial improvements while building a strong foundation for long-term RCM success.

Why a Revenue Cycle Assessment Matters

A thorough Revenue Cycle Management (RCM) Assessment is essential to uncover revenue leakage, fix operational inefficiencies, and improve overall billing performance. At ABC, we focus on the most financially impactful areas first—helping your practice recover lost revenue and build a more efficient, compliant, and profitable workflow.

Common Issues Uncovered in Our RCM Assessment

Our comprehensive analysis identifies real-world problems that affect cash flow, claim performance, and payment turnaround:

  1. Unbilled Claims that were never submitted for reimbursement
  2. Timely Filing Denials from delayed claim submission
  3. Unresolved Payer Rejections due to lack of follow-up
  4. Incorrectly Paid Claims at full charge rather than allowed amounts
  5. Downcoded CPTs reducing expected reimbursements
  6. Missing Fee Schedules, causing inaccurate payment expectations
  7. Missed Claim Batches never received by the payer
  8. Poor Denial Management, leading to lost revenue
  9. No Follow-Up on aging or denied claims
  10.  Incomplete Medical Records missing signatures, CPTs, or diagnoses

11. Unreceived Payments for specific payers or services
12. Low Clean Claim Rates increasing rejection and resubmission costs
13. Incorrect Practice Address delaying payments and communication
14. Inactive ERA/EFT Setup, slowing down electronic reimbursements
15. Out-of-Network Denials, impacting patient eligibility and reimbursement
16. Unreviewed Adjustments written off without validation
17. Late Charge Posting, resulting in missed filing deadlines
18. Incorrect Patient Balances sent in statements
19. Invalid Patient Addresses, causing statement returns
20. Unfollowed Returned Statements, affecting collections
21. E-Statement & Payment Setup Issues, delaying revenue
22. Weak Statement Follow-Up Policy, impacting collections ABC recommends collections after four unanswered statements

Prioritized for Maximun Impact

Our assessment is strategically prioritized to resolve high-revenue-impact issues first. Once these are addressed, we shift focus to correcting compliance and operational challenges to ensure sustainable long-term success.

How ABC RCM assessment Helps Your Practice

A RCM assessment can make a big difference in how your practice gets paid. Here’s what it can do:

  1. Increase revenue by 10–15% by finding missed charges and fixing billing issues
  2. Improve clean claims rate to 95%, so more claims get paid on the first try
  3. Fix clinical documentation problems like missing notes or incorrect codes
  4. Find billing mistakes that lead to denied or delayed payments
  5. Improve denial management and claims follow-up so nothing falls through the cracks
  6. Spot revenue leakage and fix gaps in your billing process
  7. Check provider network status to make sure they’re eligible for payer reimbursement
  8.  Identify and activate ERA and EFT for faster, easier payments

How ABC Stops Revenue Leakage in Your Practice

At ABC, we use a proven, proactive plan to fix revenue cycle problems and stop revenue leakage before it impacts your bottom line. Here’s how we do it:

  1. 96% of claims are paid within 20 days through fast, accurate submission and follow-up
  2. All denied claims are followed up within 24 hours to speed up resolution
  3. Focus on denial prevention, not just denial management, to reduce errors at the source
  4. Clearinghouse and insurance rejections are handled within 24 hours to avoid delays
  5. Charges and ERAs are posted within 8 hours for faster revenue recognition
  6. Claims are submitted to payers within 24 hours of charge entry to reduce payment delays
  7. Denied claims are appealed promptly to reverse incorrect payer decisions
  8. Insurance claim follow-up starts on Day 10 from submission to avoid aging AR
  9. Daily and weekly reports help identify revenue leaks and track trends

To deliver this level of insight, ABC requires full access to your Practice Management System (PMS).

Practice RCM assessment pricing starts at $800 and goes up to $2,500, based on your practice size and specific needs.