Elevate Forensic Audit + Revenue Cycle Management

Recover revenue. Reduce denials. Accelerate cash flow.

We begin with a complimentary forensic audit to uncover revenue leakage, billing errors, coding gaps, payer underpayments, and operational inefficiencies. Then we partner with your organization to correct the issues and strengthen long-term revenue performance.

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The Case for a Forensic Audit

Small errors create measurable revenue loss.

Revenue leakage is rarely caused by one obvious issue. It is usually the result of many small breakdowns across registration, authorization, documentation, coding, payer rules, denials, and follow-up.

Executive insight

Revenue performance improves when organizations move from reactive billing cleanup to a disciplined operating model that identifies failure patterns, corrects root causes, and sustains reimbursement accuracy over time.

Front-end errors multiply into larger problems

Inaccurate demographics, eligibility failures, missing authorizations, and benefit verification gaps can cause claim failures before reimbursement begins.

Documentation affects reimbursement

Incomplete documentation, non-specific codes, undercoding, duplicate billing, and unbundling can reduce payment speed, accuracy, and compliance confidence.

Denials often reveal system issues

Delayed follow-up, fragmented workflows, missed payer rule changes, aging receivables, and written-off denials erode collections over time.

Underpayments require deeper review

Contract terms, payer behavior, reimbursement patterns, and underpayment trends must be examined to identify missed revenue and recovery opportunities.

15–30% revenue loss Common preventable leakage tied to recurring billing, coding, eligibility, denial, and follow-up mistakes.

OpEx waste Rework, resubmissions, manual follow-up, and avoidable denials increase operating expense.

Regulatory risk Coding and documentation inconsistencies can create audit exposure, compliance concerns, and patient billing issues.

Elevate Forensic Audit

A comprehensive review of revenue cycle performance.

Elevate evaluates the full billing and reimbursement lifecycle to uncover revenue leakage, payer underpayments, coding issues, documentation gaps, denial patterns, and process inefficiencies.

What We Review

Revenue cycle controls.

Patient intake
Insurance verification
Clinical documentation
Charge capture
Claim submissions
Clearinghouse reports
Payer ERAs
A/R aging reports
Write-off logs
Payer fee schedules
Billing policies
Credentialing files

What We Identify

Clear findings and a path to correction.

Missed revenue
Underpayments
Coding errors
Systemic trends
Workflow bottlenecks
Unrecovered denials
Payer non-compliance
Documentation gaps
Credentialing lapses
Improper write-offs
Patient data errors
Timely filing losses

Phase 1: Audit Findings + Strategic Roadmap

The forensic audit is the starting point — not the final deliverable.

Elevate is designed to provide executive-level visibility into where revenue is being delayed, denied, reduced, or lost, while creating a prioritized roadmap for operational correction and long-term performance improvement.

01 Documented findings

Clear financial and operational findings tied to billing, coding, denials, payer behavior, and workflow performance.

02 Quantified impact

Revenue leakage, denial trends, underpayment patterns, and recoverability are assessed and prioritized.

03 Correction roadmap

CGM provides recommended fixes and a practical path for implementation through RCM services and optional AI support.

Executive Findings Report

Documented financial and operational findings.

Revenue leakage analysis
Denial trend reporting
Payer underpayment findings
Coding risks
Workflow inefficiencies
Compliance exposure review
Workflow bottlenecks
A/R performance analysis
Root cause identification
Reimbursement trends
Impact estimates
Recovery analysis

Prioritized Correction Roadmap

Clear recommendations for implementation.

Denial reduction strategy
Workflow correction plans
Documentation optimization
Coding optimization guidance
Payer escalation
Revenue recovery priorities
Front-end optimization
Operational accountability
Collections acceleration
AI workflow opportunities
Executive reporting structure
Optimization priorities

Audit Process

From forensic findings to measurable improvement.

Our audit is designed for executive clarity and operational action. The outcome is not just a report — it is a prioritized roadmap for revenue recovery, denial reduction, compliance improvement, and workflow optimization.

Data review

We analyze historical billing, coding, claims, denials, reimbursements, and payer activity across the prior review period.

Cause analysis

We isolate the operational, documentation, coding, payer, and workflow drivers behind lost or delayed revenue.

Financial impact

We quantify the opportunity and prioritize issues by recoverability, urgency, and long-term operational impact.

Remediation plan

We deliver targeted recommendations and can partner with your team to correct the issues identified.

From roadmap to execution

Once the issues are documented, CGM moves into implementation.

The audit creates the financial and operational roadmap.

Phase 2 turns that roadmap into action through revenue cycle management, denial reduction, coding support, workflow correction, executive reporting, and optional AI-enabled optimization.

Discuss Revenue Improvement

Phase 2: Revenue Cycle Correction + Implementation

CGM helps correct the issues identified during the audit.

After the forensic audit is completed, CGM partners with your organization to implement the recommendations, correct operational issues, reduce denials, accelerate reimbursement, and create better executive visibility into financial performance.

98%

Clean Claims Approval

First-pass clean claims accelerate cash flow, reduce denials, and minimize costly rework.

100%

IVR Handling

Insurance verification is handled end-to-end, reducing staff burden and front-end errors.

24/7

Billing Operations

Claims are worked around the clock, not limited to standard office hours.

70%

Cost Reduction

Reduce operating costs while preserving performance, oversight, and compliance quality.

Performance-Driven Partnership

If we don’t deliver, you don’t pay.

Our model is aligned with your success. We earn your business through performance, accountability, transparency, and measurable revenue cycle improvement.

Full CGM Services

Everything your revenue cycle needs to perform better.

12-month look-back analysis
6-month denial recovery support
Expert denial resolution
Continuous claim follow-up
Certified coding team
Dedicated practice manager
Daily real-time billing
Faster reimbursement cycles
HIPAA / SOC 2 certified
Seamless system integration
Works alongside your team
Executive reporting and transparency

AI-Enabled Operational Enhancement

AI integrated into revenue cycle implementation and optimization.

The optional AI overlay strengthens the operational improvements identified during the forensic audit and implemented through CGM’s revenue cycle management services.

Support providers while improving downstream billing accuracy.

The AI platform helps automate clinical documentation, generate summaries, improve coding completeness, reduce administrative burden, and strengthen the quality of information flowing into the revenue cycle.

AI Documentation ICD-10 / CPT Support Compliance Support Workflow Automation EMR Agnostic Patient Summaries

Live note generation AI-assisted documentation helps providers complete notes faster while reducing manual charting burden.

Intelligent coding support Supports ICD-10, CPT, HCC, MRA workflows, and documentation completeness.

Compliance reinforcement Improves documentation consistency, supports audit readiness, and strengthens compliance workflows.

Operational automation Supports administrative coordination, workflow efficiency, and operational communication.

Traditional Billing vs. CGM

A more accountable approach to revenue cycle performance.

Traditional Billing

CGM

1–3 year contracts

Month-to-month agreements

72–80% first-pass approval

98% clean claims on first submission

Reactive follow-up

Aggressive, continuous claim pursuit

Weekly or batch billing

Daily, real-time billing

High overhead and staffing costs

Up to 70% operating cost reduction

Limited visibility

Executive reporting and revenue transparency

Denials often written off

Denials actively recovered up to 6 months back

9–5 operations

24/7 revenue cycle execution

Begin With Clarity

Ready to uncover and correct revenue leakage?

Start with the Elevate Forensic Audit, then partner with CGM to correct the issues identified through targeted support, full revenue cycle management, and optional AI-enabled workflows.

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DELIVERING MEASURABLE GROWTH FOR HEALTHCARE PROVIDERS.

Business development, strategic advisory, and precision analytics built for healthcare.

Forensic Audit

Platforms

Specialized Tax

Incentives

Corporate Cost

Reduction

Telecom, Cloud & I.T. Procurement

Stay Connected

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Uncovering Hidden Opportunities: The Importance of Medical Billing and Coding Forensic Audits

Maximizing Revenue Recovery: The Case for Underpayment Audits for Healthcare Organizations