Ascentiant Health, an Ascentiant International Company

1341 Distribution Way
Suite 11 - Top Floor
Vista, CA 92081

Revenue Leakage Checklist

Identify hidden revenue gaps across your revenue cycle. Check each area you have audited in the past 12 months and note estimated dollar impact.

Payers reimbursing below contracted rates, missing fee schedule updates, or incorrect contractual adjustments.

• Contracted rates loaded and maintained accurately in billing system
• Payment variance reports run monthly by payer and CPT
• Systematic underpayment patterns identified and appealed
• Lesser-of logic and multiple procedure reductions validated on remits
• Sequestration, withholds, and value-based adjustments reconciled
• Out-of-network or silent PPO payments reviewed for correct repricing

Services rendered but never captured in the charge master or transmitted on claims.

• Charge capture lag measured — target < 24 hours from date of service
• Interface between clinical system and billing validated for completeness
• Ancillary services (labs, imaging, supplies, injections) audited against encounters
• Missed charge reports reviewed weekly by department leads
• Charge master includes all billable services performed in practice
• Late charge policy enforced with defined cutoff and escalation

Services delivered without required authorization — resulting in denials or zero-pay outcomes.

• Auth-required service list maintained by payer and procedure
• Zero-pay claims analyzed for auth-related root causes
• Retroactive authorization process defined for emergent services
• Auth numbers linked to accounts and transmitted on claims
• Denial trends for auth failures reported to scheduling and clinical teams
• Staff trained on payer portal auth submission and status tracking

Payments applied incorrectly, leaving inflated A/R, unapplied cash, or inaccurate patient balances.

• ERA/EOB auto-posting accuracy audited monthly (target 98%+)
• Unapplied payment report reviewed and cleared within 30 days
• Contractual adjustment codes mapped correctly by payer
• Duplicate payment and recoupment offsets identified and resolved
• Patient responsibility transferred accurately after payer adjudication
• Credit balance resolution process compliant with refund timelines

Reimbursement not aligned with executed contracts — fee schedule gaps, wrong effective dates, or missing addenda.

• Executed contracts on file and mapped to payer IDs in billing system
• Fee schedule effective dates validated before billing begins
• New contract rates loaded within 30 days of execution
• Annual contract review conducted for top 10 payers by revenue
• Stop-loss, carve-outs, and supplemental payments tracked separately
• Rate changes communicated to coding and contracting teams promptly