# Elevate Medical Resources: full website text
> The complete text of https://elevatemedicalresources.com/ in one file for AI assistants and search tools. Summary and key facts: https://elevatemedicalresources.com/llms.txt
> Last updated: 2026-09-25

# We Turn Failing Medical Practices
Back to Profitability.
Most billing companies want the easy accounts. We take the practices that are losing money, buried in denials, or falling behind, and we rebuild the billing system underneath them until cashflow is steady and the practice is profitable again.
- You work directly with the person doing your billing, not a call center or a rotating team.
- We work inside your existing EHR and practice management software. No new systems to learn.
- Everything you share is encrypted and handled under HIPAA-compliant protocols.
# Is Your Practice Struggling to Stay Profitable?
We specialize in practices that are overwhelmed or on the brink, rebuilding billing workflows so claims get paid, cashflow stabilizes, and your practice can breathe again.
# The Elevate Turnaround Method
Every turnaround follows the same three phases. We stop the bleeding first, then go after the money you're already owed, and then build the system that keeps your practice profitable once we've stabilized it.
## Stabilize
Stop the revenue from leaking out.
We find out exactly why claims aren't getting paid and fix the workflow so new claims go out clean, complete, and on time.
- Denial and rejection root-cause review
- Claim submission and coding cleanup
- Eligibility and documentation checks
## Recover
Go after the money you've already earned.
We work your aging A/R, correct and resubmit what can be fixed, and appeal what should have been paid in the first place.
- Aging A/R cleanup, even months or years back
- Corrected claims and resubmissions
- Denial appeals and payer follow-up
## Sustain
Keep the practice profitable.
You work directly with the person doing your billing, with the oversight and reporting that keep denials low and cashflow steady.
- Denial prevention built into the workflow
- Ongoing billing, oversight, and staff support
- Financial reporting that shows what the practice actually earns
# What Is Your Billing System Costing You?
Move the sliders to match your practice and you'll see a rough estimate of how much revenue is slipping away to denials that never get worked, and how much cash is sitting in slow A/R instead of in your account.
Monthly charges billed
Denial rate
The share of claims denied on first submission.
Denials that never get reworked
If your team is behind, this is often more than half.
Days in A/R
How long, on average, it takes to get paid after a claim goes out.
Estimated revenue lost to unworked denials each month
The same leak over a full year
This is a rough estimate based only on the numbers you enter, not a quote or a promise of results. The Revenue Rescue Assessment looks at your real claims data.
# The Real Reasons Practices Fail
Most practices don't go under because of clinical care. They fail because billing systems break down, claims pile up, denials spike, documentation slips, and cashflow collapses. We fix the underlying revenue problems that traditional billing companies overlook.
## Broken Claims Workflow
Late submissions, missing documentation, and inconsistent coding are the fastest way a practice loses money. We rebuild the claims workflow so every claim goes out clean, complete, and on time. Every time.
## Rising Denials and Lost Revenue
If your denials are piling up, your revenue is bleeding out. We find the root cause: coding errors, documentation gaps, eligibility failures, and put a system in place that prevents denials before they happen.
## A/R Backlog and Unpaid Claims
Months (or years) of unpaid claims can suffocate a practice. We clean up old A/R, recover lost revenue, and put accountability steps in place so your cashflow stops slipping through the cracks and you can finally reach profitability (and real stability) for your practice.
## Staff Overload and Documentation Issues
Most in-house teams don't have the training or the bandwidth to manage billing at the level required to stay profitable. We provide the expertise, oversight, and documentation support your staff can't realistically handle.
# Everything a Turnaround Takes, Under One Roof
Fixing the billing is where most turnarounds start, but it's rarely where they end. A practice gets back to profitability when the claims, the contracts, and the business numbers are all working, so we handle all of them instead of handing you off to three different firms.
## Revenue Cycle Management
The billing engine that gets claims out clean, gets them paid, and goes after what's owed.
- Medical coding, billing, and collections
- Denial management
- A/R recovery
- Insurance eligibility verification
- Insurance follow-up
- Patient collections
## Practice Financial Management
The full financial picture, so you know what the practice actually earns and what it costs to earn it, not just what was collected.
- Monthly financial and operational reporting
- Bookkeeping and accounting oversight
- Cash-flow and budgeting analysis
- Provider and service-line profitability
- Overhead and break-even analysis
- Payroll and staffing cost review
## Payer and Reimbursement Strategy
A close look at whether your payer contracts are paying what they should, and support when it's time to push for better terms.
- Payer and managed-care contract review
- Fee schedule analysis
- Underpayment analysis
- Reimbursement analysis and modeling
- Payer performance analysis
- Payer negotiation support
## ASC Management and Consulting
Financial, reimbursement, and operational consulting built specifically for ambulatory surgery center owners.
- Financial reporting and budgeting
- Case and procedure profitability
- Payer mix and reimbursement analysis
- Facility utilization
- Staffing and supply cost analysis
- Growth and expansion modeling
## Strong case volume doesn't always mean strong profitability.
A surgery center can stay busy and still lose ground when reimbursement lags, payer contracts underperform, staffing and supply costs creep up, or nobody knows the true margin on each procedure.
We put those pieces together so ASC owners can see which cases and contracts are carrying the center, which ones are holding it back, and what to change first.
# What Happens When We Repair a Broken Billing System
Three practices that were losing ground, and where they stood once the billing system was rebuilt.
$250K/mo
Monthly revenue, up from $100K, within 5 months
## Surgical Center Turnaround
We rebuilt the billing workflow for a failing surgical center that was drowning in denials and missing documentation. By fixing coding errors, clearing old A/R, and stabilizing submission processes, revenue more than doubled within five months.
65%
Reduction in outstanding A/R within 6 months
## Family Clinic Revitalization
A small family clinic was overwhelmed with months of unpaid claims and collapsing cashflow. We cleaned up their backlog, corrected coding inconsistencies, and implemented denial-prevention protocols, stabilizing revenue flow in under four months.
12%
Denial rate, down from 30%, within 9 months
## Orthopedic Practice Recovery
This orthopedic practice was losing thousands monthly due to preventable denials and poor documentation. After restructuring their billing workflow and improving coding accuracy, we slashed their denial rate by 60% and restored consistent reimbursements.
# Led by a Certified Medical Revenue Manager
Elevate Medical Resources was founded by Jeff Ramos, a veteran of more than 18 years in the healthcare industry who's accredited as a Certified Medical Revenue Manager (CMRM) by the Medical Revenue Management Association of America.
Our experience goes beyond traditional medical billing. We've managed an ambulatory surgery center ourselves, which gives us firsthand insight into the financial and operational challenges practice and ASC owners face every day, and our coders hold certifications from AAPC and AHIMA.
- 18+ years in healthcare
Revenue cycle, practice management, and private practice business support
- CMRM accredited
Certified Medical Revenue Manager through the MRMAA
- AAPC and AHIMA certified coders
Coding handled by credentialed professionals
- Hands-on ASC management
Experience running a surgery center, not just billing for one
# See What a Revenue Cycle Audit Actually Uncovers
These two anonymized case studies walk through real audits we've done, including where the money was going, what was driving it, and the plan to get it back. The practices' names have been removed, but the numbers are real.
## What a Revenue Cycle Audit Can Reveal
An urgent care practice with $1.45M in aging A/R and losses spread across charge capture, coding, eligibility, and follow-up.
288
Encounters never charged
40%
Estimated coding error rate
. Your white paper is ready.
## Revenue Cycle Audit Findings and a Recovery Framework
A multi-location gastroenterology practice carrying more than $18M in unresolved A/R, and the phased plan to recover it.
$814K
Recoverable denied claims
272
Coding errors found
. Your white paper is ready.
# Start With a Free Revenue Rescue Assessment
Before we talk about fixing anything, we look at where your revenue is actually going. We'll review your denials, your aging A/R, and the way claims move through your practice, then walk you through what we found and what your turnaround would look like.
There's no cost and no obligation, and you'll come away knowing where the money is leaking whether you work with us or not.
- Denial pattern review
Which payers are denying claims, for what reasons, and how much it's costing you.
- Aging A/R review
How much is sitting unpaid, how old it is, and how much of it is still recoverable.
- Claims workflow review
Where claims slow down, get missed, or go out with errors before they ever reach the payer.
- Your turnaround plan
A clear walkthrough of what we'd fix first and what it would take to get your practice profitable again.
# Frequently Asked Questions
What struggling practices ask us most when their billing system is breaking down.
How do you fix a failing or financially struggling practice?
We start by diagnosing the root revenue problems: late claims, missing documentation, coding inconsistencies, rising denials, or unpaid A/R. Then we rebuild the billing workflow from the ground up, clean up old claims, and put a system in place that stabilizes cashflow quickly.
What makes Elevate different from typical medical billing companies?
Most billing companies want clean, stable, low-maintenance practices. We specialize in practices that are overwhelmed, behind, or struggling financially. You work directly with the person doing your billing. Not a call center, not a rotating team. Our entire focus is rebuilding revenue systems so your practice becomes profitable again.
Do you integrate with my existing EHR or practice management software?
Yes. We work within your existing systems and workflows. No new software, no complicated setup. Just immediate operational improvement.
What type of practices do you work with?
We primarily help small and mid-sized practices, surgery centers, specialty clinics, and solo providers who are:
- Losing money
- Behind on claims
- Drowning in denials
- Struggling with billing staffing
- Working A/R that never gets resolved
If your practice is financially strained, that's when we deliver the most value.
Can you help recover old A/R or unpaid claims?
Yes. We specialize in cleaning up old A/R, even months or years of it. We aggressively work unpaid claims, correct errors, and appeal what should have been paid. Practices often see immediate cashflow improvement from A/R recovery alone.
How quickly can you turn around a struggling practice?
Most practices begin seeing measurable improvements in 30 to 90 days. Denials drop, A/R reduces, and cashflow stabilizes as we rebuild your billing system.
# Start Your Practice Turnaround
Tell us where your billing stands today and we'll set up your free Revenue Rescue Assessment, then schedule a call to walk you through what we found and what your turnaround plan looks like.
9100 Conroy Windermere Road, Suite 200, Windermere, FL 34786
Monday to Friday, 8:30 AM to 5:30 PM
© 2026 Elevate Medical Resources. All rights reserved.
All information submitted through this site is encrypted and handled under HIPAA-compliant protocols.

# Contact
Phone: (321) 287-0702
Email: jeff@elevatemedicalresources.com
Address: 9100 Conroy Windermere Road, Suite 200, Windermere, FL 34786
Hours: Monday to Friday, 8:30 AM to 5:30 PM Eastern

# Guides

## Why Is My Medical Practice Losing Money When We’re Busy?
URL: https://elevatemedicalresources.com/guides/why-is-my-medical-practice-losing-money/

It’s one of the most frustrating spots a practice owner can be in. The schedule is full, providers are seeing patients all day, and yet there’s less money at the end of the month than there should be. Payroll feels tight, bills get paid late, and nobody can quite explain where the revenue went.

In most cases the problem isn’t the clinical side of the practice. Patients are being seen and services are being delivered, but the money that work earns isn’t making it all the way into the practice’s account. That gap almost always lives somewhere between the moment a service is performed and the moment a payment is posted.

### Charges that never get captured

The first leak is the easiest one to miss. If a service is performed but never makes it onto a claim, the practice will never be paid for it. This happens when encounters aren’t closed out in the EHR, when a procedure or injection isn’t documented alongside the visit, or when charges are entered late and then forgotten.

Charge capture problems are hard to see from the outside because there’s no denial or rejection to flag them, since the claim simply never exists. The only way to find these gaps is to compare what was scheduled and documented against what was actually billed.

### Claims that go out wrong

A claim that leaves the practice with a missing modifier, an outdated insurance ID, a diagnosis code that doesn’t support the procedure, or missing documentation will either be rejected by the clearinghouse or denied by the payer. Each one then needs to be found, corrected, and resubmitted, which costs staff time and delays payment by weeks.

Practices usually measure this as a clean claim rate, meaning the share of claims accepted and paid on the first submission. A commonly cited target is 95 percent or higher. When that number slips, the practice is paying its team to do the same work twice.

### Denials that nobody works

Denied claims are recoverable revenue, but only if someone works them. In a busy office, the denials that are easy to fix get handled and the rest pile up in a work queue until they pass the payer’s correction or appeal deadline, and at that point the money is usually gone for good.

This is often the single biggest leak in a struggling practice. It isn’t that the practice did the clinical work wrong, it’s that the follow-up never happened because the billing staff were already stretched.

### Slow accounts receivable

Even when claims are eventually paid, slow payment hurts. Days in A/R measures how long, on average, it takes to collect after a claim goes out, and many well-run practices keep it somewhere in the 30s. When it drifts to 60 or 90 days, a practice can have plenty of revenue on paper and still struggle to make payroll, because the cash is sitting with payers instead of in the bank.

It’s also worth looking at how much of the A/R is older than 90 days. The older a claim gets, the less likely it is to be paid at all.

### Payer contracts that underpay

Some practices are paid less than they should be even on claims that go through cleanly. Payers sometimes pay below the contracted rate, apply the wrong fee schedule, or bundle services that should be paid separately. Without someone comparing payments against the contract, these underpayments can go unnoticed month after month.

Contracts themselves can also fall behind. A fee schedule that hasn’t been reviewed or renegotiated in years may no longer reflect what it costs to deliver care.

### Costs that grew faster than revenue

Not every problem is on the revenue side. Staffing, supplies, rent, and software costs tend to creep up gradually, and without regular financial reporting it’s hard to see that a provider, a location, or a service line has stopped paying for itself. Many practices only look at collections, which tells you what came in but not what it cost to earn it.

### How to find out which problem you have

Most struggling practices have more than one of these issues at once, and they tend to feed each other. A good starting point is to pull a few numbers and look at them together:

- Charges billed compared with what was scheduled and documented
- Clean claim rate and initial denial rate, broken out by payer and by denial reason
- Days in A/R and the share of A/R older than 90 days
- Payments received compared with contracted rates for your highest-volume codes
- Monthly revenue and expenses by provider or service line

If those numbers are hard to produce, that itself is a sign the billing system needs attention. A revenue cycle audit pulls them together from your real claims data and shows which leaks are costing you the most, so you know what to fix first.

Common questions:
- Why does my practice have a full schedule but no money? Usually because revenue is being lost between the visit and the payment. Common causes are charges that never get billed, claims that go out with errors, denials that are never reworked, slow collections, and payer underpayments.
- What is a good clean claim rate for a medical practice? A commonly cited target is 95 percent or higher, meaning at least 95 of every 100 claims are accepted and paid on the first submission without being corrected and resent.
- How do I know if my practice has a billing problem? Warning signs include days in A/R above 50 or 60, a growing share of A/R older than 90 days, a rising denial rate, and cash flow that doesn’t match how busy the practice is. If your team can’t easily produce those numbers, that’s a warning sign too.

## How to Lower Your Practice’s Claim Denial Rate
URL: https://elevatemedicalresources.com/guides/how-to-reduce-claim-denials/

Every denied claim costs a practice twice. First there’s the delay in getting paid, and then there’s the staff time it takes to research the denial, correct the claim, and resubmit or appeal it. When denial rates climb, billing teams fall behind, the backlog grows, and some of that money is never collected.

The good news is that most denials follow patterns. A practice that understands why its claims are being denied can usually prevent a large share of them from happening in the first place.

### The most common reasons claims are denied

Denial reasons vary by specialty and payer, but a handful of causes show up in nearly every practice:

- Eligibility and coverage problems, such as inactive coverage, the wrong payer on file, or a patient who changed plans
- Missing or expired prior authorizations and referrals
- Coding errors, including missing modifiers, codes that don’t match the documentation, and diagnosis codes that don’t support medical necessity
- Missing or incomplete documentation requested by the payer
- Duplicate claims submitted before the original was processed
- Claims filed after the payer’s timely filing deadline
- Coordination of benefits issues when a patient has more than one insurance plan

### Start by measuring it properly

You can’t fix a denial problem you can’t see. The first step is to track your initial denial rate, meaning the share of claims denied on first submission, and to break it down by payer, by denial reason, by provider, and by location. A commonly cited target for initial denials is 5 percent or lower.

Every denial comes back with a reason code from the payer. Grouping denials by those codes usually reveals that a few root causes account for most of the problem, which tells you exactly where to focus.

### Fix the front end first

A large share of denials start at the front desk, long before a claim is created. Verifying insurance eligibility before every visit, not just the first one, catches coverage changes before they turn into denials. So does confirming that prior authorizations and referrals are on file and still valid for the service being performed.

Getting the patient’s demographic and insurance details right at check-in matters more than most practices realize, because a single wrong digit in a member ID can send a claim straight back.

### Tighten coding and documentation

Coding denials usually trace back to a gap between what the provider documented and what was coded. Regular coding reviews help catch patterns, such as a modifier that’s consistently left off or a diagnosis that doesn’t support a frequently billed procedure. Certified coders, such as those credentialed through AAPC or AHIMA, are trained to catch these issues before the claim goes out.

It also helps to give providers quick feedback when their documentation is causing denials, so the fix happens at the source instead of in the billing office.

### Scrub claims before they go out

Most clearinghouses and practice management systems can check claims against payer rules before submission. Keeping those edits up to date, and actually working the claims they flag, stops many rejections and denials before they happen.

### Work every denial, and work it quickly

Prevention won’t stop every denial, so the follow-up process matters just as much. Each denial should be assigned, worked, and either corrected, appealed, or written off for a documented reason. Payers set deadlines for corrected claims and appeals, and those windows close faster than most people expect, so the oldest and highest-dollar denials should be worked first.

### Close the loop

The practices that keep denial rates low treat every denial as information. When the same reason keeps coming back, they change the workflow that caused it, whether that’s a front desk step, a coding rule, or a template in the EHR. Over time the denial rate comes down because the causes are removed, not just because the denials are worked faster.

Common questions:
- What is a good denial rate for a medical practice? A commonly cited target for the initial denial rate is 5 percent or lower. Many struggling practices run well above that, which usually points to front-end, coding, or documentation problems.
- What is the most common reason for claim denials? Eligibility and coverage problems, missing prior authorizations, coding errors, and missing documentation are among the most common. The mix varies by specialty and payer, which is why tracking denials by reason code matters.
- Can denied claims still be paid? Yes, many can. Denials can often be corrected and resubmitted or appealed, as long as it’s done before the payer’s deadline. Denials that sit unworked past those deadlines usually can’t be recovered.

## How to Recover Old Unpaid Insurance Claims and Aging A/R
URL: https://elevatemedicalresources.com/guides/how-to-recover-old-unpaid-insurance-claims/

Many practices are sitting on money they’ve already earned. It shows up on the aging report as claims that are 90, 180, or 365 days old, and after a while it starts to feel like a number nobody expects to collect. Some of it truly is lost, but a meaningful share of old A/R can often still be recovered if it’s worked in the right order and before the remaining deadlines close.

### Understand what’s actually in the backlog

The first step is to stop looking at A/R as one big number. An aging report breaks outstanding claims into buckets, usually 0 to 30 days, 31 to 60, 61 to 90, 91 to 120, and over 120 days. The older buckets are where recoverable money is most at risk.

Within each bucket, claims generally fall into a few groups:

- Claims that were never received by the payer, often because a rejection at the clearinghouse was never worked
- Claims that were denied and never corrected or appealed
- Claims that were paid incorrectly or underpaid
- Claims pending with the payer for more information, such as records or an itemized bill
- Balances that belong to the patient after insurance paid its share

Each group needs a different action, so sorting the backlog this way is what turns it from an overwhelming number into a work plan.

### Know your deadlines

Every payer has rules about how long you have to file a claim, correct it, and appeal a denial. Medicare generally allows claims to be filed up to one year from the date of service, and commercial payers often set shorter filing limits that vary by contract. Appeal windows are separate and also vary by payer.

Because these windows are different for every payer, the backlog should be prioritized with them in mind. A claim that’s close to a deadline needs attention before a newer claim with more time left.

### Work the highest-value claims first

Not every old claim is worth the same effort. A practical approach is to sort by dollar amount and deadline, then work the largest balances that are still within a filing or appeal window first. Small balances with no realistic path to payment may be better written off with a documented reason, so the team’s time goes where it can actually recover money.

### Find out why each claim is stuck

For every claim, the key question is why it hasn’t been paid. Checking the payer portal or calling the payer usually answers it. Sometimes the fix is as simple as resubmitting a claim the payer never received, and sometimes it means gathering records, correcting codes, or writing a formal appeal.

When claims are resubmitted or appealed, keep proof of timely filing, such as clearinghouse acceptance reports. That documentation is often what gets an old claim paid when a payer says it was filed late.

### Don’t forget underpayments

A claim that was paid isn’t always a claim that was paid correctly. Comparing payments against your contracted rates can reveal underpayments that are still eligible for an appeal. These are easy to overlook because the claim shows as closed.

### Stop the backlog from rebuilding

Clearing old A/R helps cash flow right away, but the backlog will come back unless the cause is fixed. That usually means working denials and rejections every week, following up on claims at set intervals instead of waiting, and tracking days in A/R and the share of A/R over 90 days as regular numbers the practice watches.

Recovering old A/R works best as a focused project, sometimes called an A/R cleanup or recovery effort, run alongside the day-to-day billing so the current claims don’t fall behind while the old ones are being worked.

Common questions:
- Can you still collect on old insurance claims? Often, yes. Claims that were never received, were denied and never appealed, or were underpaid can frequently still be recovered if they’re within the payer’s filing or appeal window. Claims past every deadline usually can’t be.
- How long do you have to file a claim with Medicare? Medicare generally allows claims to be filed up to one year from the date of service. Commercial payers set their own limits, which are often shorter and vary by contract.
- What should I work first in an A/R backlog? Start with the highest-dollar claims that are closest to a filing or appeal deadline, then work down. Very small balances with no realistic path to payment may be better written off with a documented reason.

## Outsourced vs. In-House Medical Billing: What It Really Costs
URL: https://elevatemedicalresources.com/guides/outsourced-vs-in-house-medical-billing/

When a practice starts to struggle with billing, the question of whether to keep it in-house or outsource it usually comes up. It’s tempting to compare the salary of a billing employee with the fee a billing company charges and call it a decision, but that comparison leaves out most of what billing actually costs.

### What in-house billing really costs

The visible cost of in-house billing is payroll, but the full picture is wider:

- Salaries, benefits, and payroll taxes for billing and coding staff
- Practice management software, clearinghouse fees, and coding tools
- Training and certification to keep up with coding and payer rule changes
- Coverage for vacations, sick days, and turnover, including the time it takes to hire and train a replacement
- Management time spent overseeing the billing team
- Revenue lost to denials that aren’t worked, claims that go out late, and A/R that ages past recovery

That last item is often the largest and the least visible. A billing team that’s stretched thin may cost less on paper while quietly leaving far more uncollected.

### What outsourced billing really costs

Billing companies are commonly paid in one of a few ways, such as a percentage of what they collect, a flat fee per claim, or a flat monthly fee. Each model has tradeoffs. A percentage of collections ties the billing company’s income to what the practice actually receives, while flat-fee models can be easier to budget for but don’t reward collecting more.

There are also costs beyond the fee. Transitions take work, the practice still needs someone to handle charge entry and front desk tasks, and a poor fit with a billing company can be as expensive as a struggling in-house team.

### The tradeoffs that matter more than price

Price matters, but these questions usually decide whether an arrangement works:

- Who actually works your claims, and will you be able to reach that person directly?
- Will they work inside your existing EHR and practice management system, or require you to change software?
- How do they handle denials and old A/R, and do they report on them?
- What will you be able to see each month, such as denial rates, days in A/R, and collections by payer?
- What happens to your data and access if you end the relationship?

Some billing companies prefer practices that are already running smoothly, because clean practices are easier to bill for. A practice that’s behind or struggling should ask directly whether a company takes on turnaround work, since cleaning up a backlog is different from maintaining a healthy account.

### A hybrid approach

It doesn’t have to be all or nothing. Some practices keep front desk tasks and charge entry in-house and outsource coding, claims, and follow-up. Others bring in outside help for a specific project, such as clearing aging A/R or reducing denials, and then decide how to handle billing long term.

### How to decide

Before choosing, measure how your current billing is performing. Your clean claim rate, denial rate, days in A/R, and share of A/R over 90 days show whether the problem is capacity, process, or expertise. If the numbers are strong, keeping billing in-house may be the right call. If they’re slipping, the real cost of staying the course is the revenue that isn’t being collected, and that’s the number to compare against any outside fee.

Common questions:
- Is it cheaper to outsource medical billing? It depends on how well in-house billing is performing. The fair comparison includes staff, software, training, turnover, management time, and the revenue lost to unworked denials and aging A/R, not just a salary compared with a fee.
- How do medical billing companies charge? Common models are a percentage of collections, a flat fee per claim, or a flat monthly fee. A percentage of collections ties the company’s income to what the practice actually receives.
- What should I ask a medical billing company before hiring them? Ask who will work your claims and whether you can reach them directly, whether they work in your existing software, how they handle denials and old A/R, what they report monthly, and what happens to your data if you leave.

## What a Revenue Cycle Audit Looks At, and What It Usually Finds
URL: https://elevatemedicalresources.com/guides/what-is-a-revenue-cycle-audit/

A revenue cycle audit is a structured review of how a practice gets paid, from the moment a patient is scheduled to the moment the last dollar is collected. Its purpose is to find where revenue is being lost or delayed and to put a number on it, so the practice knows which problems are worth fixing first.

It’s different from a coding compliance audit, which focuses on whether services were coded correctly for regulatory purposes. A revenue cycle audit looks at coding too, but its main question is financial: is the practice collecting everything it has earned, and how quickly?

### What an audit reviews

A thorough audit usually follows the claim through every stage:

- Scheduling and registration, including whether patient demographics and insurance details are captured correctly
- Eligibility verification and prior authorization, and whether they happen before the visit
- Charge capture, comparing what was scheduled and documented with what was billed
- Coding accuracy, including modifiers and whether diagnosis codes support the services billed
- Claim submission, including rejection rates at the clearinghouse and how quickly claims go out
- Denials, broken down by payer, reason, and provider
- Payment posting, including whether payments match contracted rates
- A/R follow-up, including aging, days in A/R, and how old claims are being worked
- Patient collections, including statements and balances owed after insurance

### What audits commonly uncover

Every practice is different, but some findings come up again and again:

- Encounters that were documented but never billed
- Coding errors that lead to denials or to services being paid at a lower rate than they should be
- Denials that were never reworked and are approaching or past their deadlines
- Large balances in the over-90 and over-120 day A/R buckets
- Payments below contracted rates that no one flagged
- Eligibility and authorization gaps that cause preventable denials
- Workflows that depend on one person, so work stops when that person is out

In practices that have been struggling for a while, it’s common for an audit to find several of these at once, with a meaningful amount of recoverable revenue tied up in old claims.

### What you should get at the end

A useful audit ends with more than a list of problems. It should put an estimated dollar value on each issue, separate what can still be recovered from what’s already lost, and lay out a prioritized plan. The fixes that recover the most money or stop the largest ongoing leak should come first.

### How often to do one

Many practices benefit from a full review once a year, with key numbers like denial rate and days in A/R tracked every month in between. An audit is especially worth doing when cash flow drops without an obvious reason, after a change in billing staff or software, or before deciding whether to outsource billing.

### Seeing an audit in practice

Elevate has published two anonymized white papers that walk through real audits, one for an urgent care practice with $1.45M in aging A/R and one for a multi-location gastroenterology practice. They show what the audits found, what was driving the losses, and the plan to recover the revenue.

Common questions:
- What is a revenue cycle audit? It’s a structured review of how a practice gets paid, from scheduling and registration through coding, claims, denials, payment posting, and collections. Its goal is to find where revenue is being lost or delayed and estimate how much.
- How is a revenue cycle audit different from a coding audit? A coding audit focuses on whether services were coded correctly for compliance. A revenue cycle audit includes coding but looks at the whole payment process, asking whether the practice is collecting everything it has earned and how quickly.
- How often should a medical practice audit its revenue cycle? Many practices benefit from a full review once a year, with denial rate, days in A/R, and similar numbers tracked monthly. An audit is especially worthwhile when cash flow drops unexpectedly or after staff or software changes.

## Why an Ambulatory Surgery Center Can Be Busy and Still Lose Money
URL: https://elevatemedicalresources.com/guides/why-is-my-surgery-center-losing-money/

Ambulatory surgery centers can look healthy from the outside. The rooms are booked, surgeons are bringing in cases, and volume is steady or growing. Yet many ASC owners find that margins are thinner than they expected, or that the center is losing ground even as it gets busier.

The reason is that an ASC’s profitability depends on the details of every case, including what it costs to perform, how it’s coded, what each payer pays for it, and how quickly that payment arrives. Volume can hide problems in all of those areas.

### Not every case is profitable

Different procedures carry very different costs and very different reimbursement. A case with an expensive implant or long room time can lose money under one payer’s contract and make money under another. Without case-level costing, meaning a clear view of what each procedure costs in staff time, supplies, implants, and room time compared with what it’s paid, it’s hard to know which cases are carrying the center and which are holding it back.

### Payer contracts that don’t fit the case mix

ASC contracts often have terms that matter a great deal for specific procedures, such as whether high-cost implants are paid separately, how multiple procedures in the same session are reimbursed, and which fee schedule applies. Medicare and many commercial payers reduce payment for additional procedures performed in the same session, so the way cases are scheduled and coded affects what the center is paid.

A contract that made sense years ago may not match the center’s current case mix. Reviewing contracts against actual cases often shows where the center is underpaid or where it should push for better terms.

### Supply and implant costs that creep up

Supplies and implants are among the largest costs in most surgery centers. Prices rise, preference cards drift, and items get opened and not used. When supply costs aren’t tracked by case and by surgeon, they can quietly erase the margin on procedures that should be profitable.

### Staffing and utilization

Staffing costs depend on how efficiently rooms are used. Late starts, long turnovers, gaps in block time, and cases that run over all mean paying staff for time that doesn’t produce revenue. Utilization data shows whether the center is getting full value from its rooms and staff.

### Billing problems that hit harder in an ASC

The general billing issues that affect any practice, such as denials, missing authorizations, coding errors, and slow A/R, tend to cost more in a surgery center because each claim is larger. A single denied case can represent a significant amount of revenue, and authorization problems are especially costly when they’re discovered after the procedure.

### How owners can see what’s really happening

The centers that stay profitable look at their numbers by case, by procedure, by payer, and by surgeon, not just in total. Useful questions to answer include:

- What does each of our most common procedures cost, and what does each payer pay for it?
- Which payer contracts underpay for our current case mix?
- How are supply and implant costs trending by procedure and surgeon?
- How well are our rooms and block time being used?
- What is our denial rate and days in A/R, and which payers are slowest?

Answering those questions takes financial and reimbursement analysis that goes beyond standard billing. It’s the kind of work that benefits from someone who has managed a surgery center and understands how clinical activity turns into financial performance.

Common questions:
- Why is my surgery center losing money if case volume is strong? Volume can hide problems with case costs, payer contracts, supply and implant spending, room utilization, and billing. Some procedures may lose money under certain contracts, which only shows up in case-level analysis.
- How do payer contracts affect ASC profitability? Terms such as whether implants are paid separately, how multiple procedures are reimbursed, and which fee schedule applies can make the same procedure profitable under one payer and unprofitable under another.
- What financial reports should an ASC owner review? Case and procedure profitability, payer mix and reimbursement, supply and implant costs by procedure and surgeon, room and block utilization, denial rate, and days in A/R by payer.