01
Front-End Errors & The Ripple Effect
Inaccurate patient demographics, eligibility failures, missing authorizations, and benefit verification gaps can cause claim failures before reimbursement begins.
ELEVATE
Medical Revenue Cycle Forensic Audit
Unlock Hidden Revenue. Drive Measurable Growth.
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.
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.
Front-End Errors &
02
Coding & Documentation Gaps
Incomplete documentation, non-specific codes, undercoding, duplicate billing, and unbundling can reduce payment speed, payment accuracy, and compliance confidence.
03
Denial & A/R Inefficiency
Delayed follow-up, fragmented workflows, missed payer rule changes, aging account receivables and written-off denials can quietly erode collections over time.
04
Payer Underpayments
Contract terms, payer behavior, reimbursement patterns, and underpayment trends require deeper review to identify missed revenue and recovery opportunities.
15–30% Revenue Loss
Common preventable revenue loss tied to recurring billing, coding, eligibility, denial, and follow-up mistakes.
Higher Cost
Rework, resubmissions, manual follow-up, and avoidable denials increase administrative burden and operating expense.
Greater 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
Billing, coding, reimbursement, and 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
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. We solve the root cause.
Financial Impact
We quantify the revenue 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, ensuring lasting results.
Measurable Financial Impact
The audit identifies the opportunity. CGM helps capture the revenue.
Providers that implement the findings from the Elevate Forensic Audit and partner with CGM for ongoing revenue cycle management commonly experience 10%–20% annual revenue improvement through reduced denials, stronger collections, improved coding accuracy, workflow optimization, and improved reimbursement performance.
CGM Revenue Cycle Management
Operational support to correct issues and improve collections.
CGM is built to help providers reduce denials, accelerate reimbursements, recover missed revenue, lower overhead, 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
Optional AI Platform
AI-enabled CGM support for documentation, coding, and workflow acceleration.
Our optional AI overlay supports revenue cycle performance by helping reduce administrative burden, strengthen documentation, support coding accuracy, and accelerate operational workflows.
AI + Revenue Cycle
Support providers while improving downstream billing accuracy.
The AI platform helps automate clinical documentation, generate summaries, support coding completeness, and improve the quality of data flowing into the revenue cycle.
AI Documentation
ICD-10 / CPT Support
Compliance Support
EMR Agnostic
Patient Summaries
Optional Capabilities
What the AI layer can add.
Live Note
Generation AI-assisted documentation
helps providers complete
notes faster and reduce
manual charting time.
Generation AI-assisted documentation
helps providers complete
notes faster and reduce
manual charting time.
Intelligent
Coding Supports ICD-10, CPT,
code extraction, MRA,
HCC workflows, and
documentation completeness.
Coding Supports ICD-10, CPT,
code extraction, MRA,
HCC workflows, and
documentation completeness.
Compliance
Support Improves documentation
consistency, supports audit
readiness, and strengthens
compliance workflows.
Support Improves documentation
consistency, supports audit
readiness, and strengthens
compliance workflows.
Workflow
Automation Supports summaries,
handoffs, triage, scheduling,
administrative workflows,
and patient communication.
Automation Supports summaries,
handoffs, triage, scheduling,
administrative workflows,
and patient communication.
Traditional Billing vs. CGM
Why we outperform traditional billing companies.
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.
