Medical practice operations audit Hours fighting insurers. Claims rejected and refiled. We find where the money leaks.
Denials that repeat, rejected claims waiting on rework, care delivered and not yet collected. In two weeks, from aggregate practice reports, we put a monthly dollar figure on each one.
- Fixed fee
- $4,500
- Length
- Two weeks
- Access to records
- Read-only
For independent practices doing $1M+ a year.
+1 (202) 600-6027Mon–Fri, 9 a.m.–6 p.m. ET · A real person answers or calls you back the same business day.After hours? Book the call online: one form, no calendar
Sound familiar?
What physician-owners say about the money they can’t find.
01
Hours spent fighting insurance companies
Prior auths and appeals land on the same front desk and billing staff. Nobody counts the hours, so their cost never shows up on a report.
02
Denials that come back for the same reason
The same denial reason code returns month after month. Fixing it at the source is nobody’s job, so staff rework it one claim at a time.
03
Rejected claims stuck in rework
A claim bounces on a format error, waits in the rejection queue, and refiling it competes with today’s visits. The backlog has no end date.
04
Care delivered, cash not yet in
Visits are done and charted, but the cash depends on claims leaving, clearing and getting paid. No report shows how much sits in between.
05
Charges that never get captured
A service delivered in the room never reaches the claim. With nothing billed, nothing gets denied either, so nothing flags it.
06
More visits for the same profit
Costs rise while payment per visit stays flat. Payers set the rate; what happens to each claim after the visit is the part the practice controls.
Paraphrased from public owner forum threads and trade-press interviews — not from our clients.
None of this is fixed by bringing in more business. Each leak sits in work already on the books.
Where it stalls
From the first call to the cleared payment: where the money stalls.
- Call
- Hand-off 01 to Visit
- Hand-off 02 to Charge
- Hand-off 03 to Claim
- Hand-off 04 to Payer
- Hand-off 05 to Paid
- Hand-off 06 to Margin
- Hand-off 02 · Visit → Charge
Services delivered in the room that never reach a charge line.
- Hand-off 04 · Claim → Payer
Rejected claims waiting in the queue, refiled when someone gets to them.
- Hand-off 05 · Payer → Paid
Denial reasons that repeat month after month, worked one claim at a time.
- Hand-off 06 · Paid → Margin
Payer hours and rework never set against what each visit pays.
Before any new software
Large companies are spending heavily on AI. Few can show what it returned.
7%
of 2,145 senior leaders at companies with $100M+ in revenue reported having established a return on AI — while planning to spend an average of $188 million each on it.
Source: KPMG Global AI Pulse, Q2 2026
Those are companies with their own IT departments and budgets. A smaller business that buys a tool on a hunch has less room for the same mistake.
Leaders with strong visibility into costs were five times as likely to report a return on AI (15% against 3%). The same release adds that without clear ownership, decisions fragment and impact gets harder to track.
Source: KPMG Global AI Pulse, Q2 2026
Free · two taps · no email
Check one hand-off yourself, right now.
Three questions, from your own records
Which three denial reason codes came back most often last quarter, and which step upstream causes each one?
How many rejected claims are waiting in the clearinghouse queue today, and how old is the oldest?
What is the typical number of days from date of service to claim submission, provider by provider?
If an answer takes digging, note where the record lives. That is where the Review starts.
Free self-check · two taps · no email
Hand-off 5 of 6 · Invoice → Payment
Choose the answer that sounds like your business.
That was one of six hand-offs where money changes hands, from first inquiry to collected cash. The other five take about three minutes and end in a dated sheet that names where to start.
How it runs
Two weeks, $4,500, one finding you can act on.
Day 0
A 20-minute call
Fit, not yet, or not us. No deck, no payment.
Days 1–14
We read the records
Read-only exports from the systems you already run. Nothing switched off, nothing to install.
Day 14
The findings, in writing
Each leak with a monthly dollar figure, the order to fix them in, and the first fix to start the next morning — the practice’s to keep whatever the physician-owner decides.
$2,250 to begin, the balance when the report arrives. The fee does not change with what the Review finds, and the written report is yours to keep.
What we price
Each leak gets a monthly dollar figure.
Prior authorizations, appeals and payer follow-ups worked last quarter, counted from the queues and logs, and the staff hours they took
Denials by reason code and payer — the share appealed, the share overturned, the share written off, timely-filing write-offs included — and the codes that return month after month
Clearinghouse rejections waiting in the queue, how long each sat before refiling, and the ones parked as if they were denials
Charge lag: visits waiting behind unsigned notes and open encounters, and the dollars sitting between the visit and the paid claim
Services delivered in the room with no charge line, found by setting orders and procedures against the charges billed
Payer hours and rework set against what each visit pays, by payer, so the cost of working a claim sits on one page
Who runs it
Small on purpose. Senior on purpose.
A team with ten-plus years in strategic consulting and business-process automation. Before Lumina, our people built and ran revenue operations inside a Fortune 500 US financial institution.
Tamara Stepanyan, founder
No client case studies yet — we would rather tell you that than invent one.
Before you call
Questions physician-owners ask first.
We outsource billing. Doesn’t our billing company already handle denials?
A billing company works the claims it receives. Several hand-offs happen before a claim exists: the eligibility and authorization check, the charge captured in the room, the note that isn’t signed yet. After it, a rejection can sit in the clearinghouse queue as if it were a denial. The Review lays out denials by reason code and payer, so the practice and the billing company work from the same numbers. It doesn’t replace the billing company.
Does our billing company have to take part?
The first pass runs on reports the practice can export itself. Where a report sits with the billing company, the practice requests it. The billing company’s work is not graded, and both sides get the same numbers.
Our PM system already gives us dashboards. What would the Review show that they don’t?
The dashboards report what was entered. A charge never captured leaves nothing to deny; a rejection parked in the clearinghouse never reaches the denial report; and a reason code that returns every month looks like normal volume one claim at a time. The Review reconciles those records against the PM and prices each gap in monthly dollars. The fix list starts inside the systems the practice already runs. There is no software to switch to.
Our denial rate looks normal. Is there still something to price?
Possibly, and the rate alone won’t say. A rejected claim never enters processing, so it can sit outside the denial rate while the filing clock runs; for Medicare that clock is one calendar year from the date of service, and a late-filing denial cannot be appealed (cited further down this page). The Review reads charge lag by provider, rejections still open and timely-filing write-offs by month next to the denial rate.
HIPAA: what does the practice actually hand over?
The first pass runs on aggregate reports the practice exports itself: counts, dollar totals, aging buckets and denial reason codes, with no patient names, phone numbers or other identifiers. Patient-level records are requested only under a signed BAA; otherwise the Review works from aggregate reports only. Chart notes and clinical content are never part of the Review.
Is this an RCM vendor that takes a percentage of collections?
No. The Revenue Review is a flat $4,500 for two weeks, with a written report the practice keeps whatever it decides next. The fee is never a percentage of collections, and nothing is installed or switched off; beyond pulling a few extracts, the front desk stays on the phones. It starts with the 20-minute call, before any payment, ideally with the practice administrator on the line, and if the fit is wrong, that call says so.
Related reading
In depth
The long version, for an owner who wants the detail.
The outside numbers, each with its source
Medicare claims must be filed within one calendar year of the date of service, extended only in narrow cases such as an error by Medicare or its contractor; a denial for late filing is not an appealable determination, and a claim Medicare rejects for missing or invalid data never enters processing, so it must be corrected and resubmitted within the same year.
Of 132,899 firms classified as offices of physicians, except mental health specialists (NAICS 621111), in 2022, 47,418 had annual receipts of $1 million or more.
None of these figures describes any one practice. They give context: the Census count sizes the field at $1 million in receipts and up, and because it counts enterprises of every ownership, it is wider than the independent practices alone. Medicare’s filing clock runs from the date of service, so for Medicare claims charge lag has a hard limit. The Review counts the practice’s own records.
The next step
Tell us what isn’t getting followed up. We’ll tell you if we can help.
- Send the form beside this. A person reads it, not a bot or a ticket queue. We call you back the same business day.
- 20-minute call: fit, not yet, or not us.
- If it fits: the Revenue Review, $4,500 flat, two weeks.
+1 (202) 600-6027Mon–Fri, 9 a.m.–6 p.m. ET · A real person answers or calls you back the same business day.