Revenue Leakage Identifier and Remediation Planner

Revenue Leakage Assessment — Practice-Wide Audit Findings Assessment Scope: 6-month rolling review, all service lines Total Estimated Annual Revenue Leakage Identified: $312,000 LEAKAGE CATEGORY 1 — SERVICES RENDERED BUT NOT BILLED ($89,400 estimated annually) Finding: In-office ancillary services (point-of-care lab testing, EKG interpretation, wound care supplies) are frequently rendered without a corresponding charge capture. Providers performing these services at the point of care are not consistently generating charge tickets. Source identified: Nursing intake logs document ancillary services performed that have no corresponding billing line item on 18% of audited charts. Corrective action: Implement nursing charge capture responsibility for ancillary services. Embed charge prompt in nursing documentation workflow. LEAKAGE CATEGORY 2 — UNDER-CODED EVALUATION AND MANAGEMENT ($74,800 estimated annually) Finding: E&M coding is consistently one level below what the documentation supports, concentrated in two attending physicians. Source identified: Physician self-assessment coding habits — providers are coding conservatively due to audit concern. Education rather than behavior correction is the appropriate response. Corrective action: Monthly coding feedback reports with specific chart examples. Show providers what documentation they already write that supports higher complexity coding. LEAKAGE CATEGORY 3 — UNCOLLECTED PATIENT BALANCES ($68,200 estimated annually) Finding: 847 patient accounts in 90+ day AR have received no collection activity beyond initial statement. Source identified: No defined collection protocol after second statement mailing. Corrective action: Implement structured 3-step patient collection protocol: statement, personal call, payment plan offer. Add financial counselor touchpoint before 90-day mark. LEAKAGE CATEGORY 4 — TIMELY FILING LOSSES ($79,600 estimated annually) Finding: 143 claims denied for timely filing in past 6 months. Majority caused by late charge entry from off-site locations. Corrective action: Establish 72-hour maximum charge entry standard. Monitor compliance weekly.