Revenue Cycle Analytics

Revenue Cycle Analytics: Stop Discovering Problems at Month-End

Denial analysis, billing optimization, and payer performance tracking implemented by revenue cycle consultants who understand healthcare billing — not generic BI analysts who learned CPT codes last week.

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$150Kaverage annual revenue missed from Level 3 vs. Level 4 coding
The Revenue Cycle Problem

Month-End Reporting Shows You What Already Happened

The standard revenue cycle reporting model is retrospective: your billing team compiles denials at month-end, identifies the patterns, escalates to coding or clinical staff, and waits for next month to see if anything changed. By the time a denial pattern is visible in a monthly report, the practice has already lost 4–6 weeks of revenue.

Vizier's revenue cycle dashboards update every time billing data is uploaded — which means a spike in CO-97 denials from a specific payer is visible in week two, not at month-end when it's too late to address it in the same billing cycle.

We configure revenue cycle analytics using the same denial reason code taxonomy your billing team already uses. The dashboard speaks the language of your revenue cycle staff — not a translation that requires cross-referencing with your billing system.

COMMON DENIAL REASON CODES WE TRACK
CO-4
Service inconsistent with modifier used or a required modifier is missing
CO-97
Payment adjusted because the benefit for this service is included in the payment/allowance
PR-1
Deductible amount — patient responsibility
CO-11
Diagnosis inconsistent with procedure
CO-16
Claim lacks information or has submission/billing error
CO-18
Duplicate claim/service
Coding Gap Identification

The Level 3 to Level 4 Coding Opportunity

The average physician group leaves $150,000 per year in Level 4 (99214) billing on the table by defaulting to Level 3 (99213). The documentation for a Level 4 visit exists — the clinical encounter was complex enough — but the code wasn't selected because providers habitually bill conservatively or documentation doesn't capture what was actually done.

Vizier's coding gap analysis compares your visit-level E/M code distribution against national benchmarks for your specialty. When your 99213 rate is 20 points above specialty average and your 99214 rate is correspondingly low, the gap analysis quantifies the revenue at risk and identifies which providers and visit types show the largest discrepancy.

This isn't about upcoding — it's about ensuring that documentation specificity matches visit complexity. When documentation supports Level 4, the claim should reflect it. The coding gap report tells you where documentation improvement training would have the most immediate revenue impact.

99211
Minimal — nurse visit, no physician required
99212
Low complexity — straightforward presenting problem
99213
Moderate complexity — most common for established patients
99214
High complexity — detailed history, multiple problems, or complex decision-making
99215
Very high complexity — comprehensive, multi-system, high-risk decision-making
Avg Gap
$150K/yr missed by practices billing 99213 when 99214 is documented
Payer Performance Analysis

Not All Payers Are Created Equal — See the Data

Days to Payment
Track average payment timeline by payer and compare against contract terms. When United pays in 22 days and Cigna takes 47, and both are supposed to pay in 30, one is consistently in breach — and you have the data to support a conversation.
Denial Rate by Payer
Payer-specific first-pass denial rates reveal patterns that aggregate denial statistics hide. A 12% overall denial rate that's driven by a 28% denial rate from one payer tells a different story than distributed denials across all payers.
Appeal Success Rate
Track how often you win on appeal by payer and by denial reason code. When your appeal success rate against a specific payer on CO-97 denials is 67%, that's a systematic pattern worth pursuing systematically rather than case-by-case.
Prior Auth Burden
Prior authorization denial rates and administrative time by payer. When one payer requires prior auth for 40% of your procedures and denies 30% of those requests, the administrative cost of that payer relationship becomes quantifiable.
Net Collection Rate
Target above 95%. Net collection rate measures what you actually collected versus what you were contractually allowed to collect. Below 95% means money is being written off, taken as adjustments, or sent to collections at a rate that suggests a systematic billing problem.
A/R Days by Payer
Goal: under 40 days overall. Payer-specific A/R trending identifies which relationships are slowing cash flow. When your A/R days for Medicaid are 68 and Medicare is 19, you have two very different collection processes running in parallel.
What You Get

Revenue Cycle Visibility That Updates With Every Billing Export

✓Monthly denial dashboard with reason code breakdown by payer and CPT code
✓Payer scorecard: days to payment, denial rate, appeal success rate, prior auth burden
✓Coding gap report: E/M code distribution vs. specialty benchmark with revenue at risk
✓A/R aging analysis with payer-specific trending and threshold alerts
✓Prior authorization burden analysis by payer and procedure category
✓Appeal tracking with win rate by payer and denial reason code

Revenue cycle analytics in Vizier don't require a full-time analyst to maintain. The billing team uploads the monthly export, Vizier calculates updated denial rates and payer performance, and the report is ready for the weekly revenue cycle meeting without anyone compiling spreadsheets.

The configuration is done by consultants who know the difference between a CO-97 and a CO-4 denial, understand why prior auth burden should be measured per procedure category rather than in aggregate, and can help your billing staff interpret what the data is telling them — not just show them a chart.

How It Works

From Denial Audit to Ongoing Revenue Cycle Monitoring

STEP 01
Denial Rate & Reason Code Audit
We pull three months of billing data and calculate your baseline: first-pass denial rate, denial distribution by reason code and payer, A/R aging, and E/M code distribution. This establishes what you're starting from and where the biggest opportunities are.
STEP 02
Vizier Revenue Cycle Configuration
We configure Vizier for your billing data: payer mapping, denial reason code categories, E/M code benchmarks for your specialty, A/R aging thresholds, and net collection rate alerts. The first payer scorecard generates automatically from your billing export.
STEP 03
Ongoing Monitoring & Coding Gap Analysis
Monthly billing uploads trigger automatic dashboard updates. The coding gap report updates quarterly with fresh benchmark comparisons. When denial rates spike above threshold on a specific payer, the alert fires before you find out at month-end.
Timeline & Outcomes

What to Expect and When

Revenue cycle configuration typically takes four weeks. The most time-sensitive deliverable is the coding gap analysis — most practices that have it run for the first time identify revenue recovery opportunities that pay for the engagement cost within a single billing cycle.

Week 1
Denial rate and reason code audit using three months of billing data
Week 2
Vizier configuration for billing data ingestion and payer mapping
Week 3
First payer scorecard and denial reason code dashboard delivered
Week 4
Coding gap analysis: E/M distribution vs. specialty benchmark with revenue at risk
Month 2+
Ongoing monthly monitoring, quarterly coding gap refresh, denial trend alerts
$150K
average annual revenue from missed Level 4 billing
15%
average denial rate reduction after 90 days
67%
appeal success rate on properly documented claims
<40 days
target A/R days — the benchmark we configure to
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Get Started

See Your Denial Rate and Coding Gap in the First Session

Schedule a 30-minute consultation. Bring three months of billing data and we'll calculate your baseline denial rate, identify the top three reason code patterns, and estimate the coding gap opportunity before any engagement begins.

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