It's an architecture problem. Fragmented tools. Reactive workflows. Eligibility verification that stops one step too early. 86 to 90% of denials are entirely preventable, and most of the leakage traces back to the same handful of upstream gaps.
We built a 12 page scorecard with 20 best practice benchmarks across 5 categories. Score yourself honestly. The number itself matters less than the pattern. The pattern tells you exactly where to invest next.
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On 2 to 4% industry margins, there is no capacity to absorb rework costs that should never have occurred. The most expensive denials are not coding errors. They are registration and eligibility failures that happen before a claim is ever submitted.
Pure administrative cost to rework every denied claim before you ever recover a dollar.
More than 1 in 9 claims rejected on first pass across the industry.
When systematic denial management is absent, two thirds of denied revenue walks away.
25% of collectible revenue surrendered to reactive workflows. The scorecard tells you your share.
67% of providers believe AI can improve claims processes. Only 14% actually use it for denial reduction. Among those who do, 69% report significantly improved claim success rates, and high performers see denial rates drop 30 to 40%. The scorecard helps you measure exactly where that gap exists in your own operation.
The scorecard does not measure effort. It measures architecture. Each category targets a distinct layer of denial prevention. Check only the items your operation performs consistently and systematically. Not occasionally. Not when staff remember to.
Multi stage verification cadence and intake workflow. The most expensive denials are preventable here, before any claim is ever submitted.
Platform consolidation and automation quality. Fragmented stacks carry a 15 to 20% operational cost premium that quietly destroys margins.
Pattern identification and systemic correction. Mature operations engineer denials out. They do not chase them.
Live metrics versus best practice benchmarks. Clean claim rate, denial rate, days in A/R, net collection rate, and cost to collect.
Process design, escalation paths, and documentation. The infrastructure under your staff determines whether their effort compounds or leaks.
Significant denial revenue leakage. Reactive workflows are compressing margins in ways that may not be visible yet but will be.
Partial prevention infrastructure exists but gaps are costing you. Without architectural improvement, denial rates will compound.
Strong foundation. Targeted improvements in your lowest scoring categories will produce measurable margin gains within six months.
Best practice architecture in place. Focus shifts to optimization, AI integration, and competitive differentiation.
Plus a live KPI comparison page covering clean claim rate, denial rate, days in A/R, net collection rate, and cost to collect, with best practice and warning thresholds for each.
A defensible benchmark you can use to compare your operation against the industry, set targets, and tell your investors what you're optimizing.
A diagnostic that surfaces the architectural gaps your weekly stand up keeps deferring. Use it as a board prep tool or a quarterly self audit.
Quantify the architecture risk inside your billing operation, in language that maps directly to margin and cost to collect.
Quarterly self audit for tracking architectural maturity over time.
Board and investor briefing tool that translates ops health into margin language.
Vendor and acquisition diligence framework when you're evaluating an RCM target.
“We scored a 47. The number was a punch in the stomach but the section breakdown told us exactly which two upgrades would move us into the sixties before year end. That clarity was worth the ten minutes.”
About ten minutes if you know your operation well. Add another fifteen if you want to enter your live KPI numbers on the benchmark page. The action plan worksheet at the end is open ended and you can come back to it.
No. The PDF is yours. You score yourself privately. There is no submission, no scoring portal, no shared report. The only thing we capture is your email so we can send the download.
Yes. The 20 items are architecture markers, not headcount markers. Small operations can score in the 80s if their infrastructure is right. Large operations can score in the 30s if it isn't.
Yes. Clean claim rate above 95%, denial rate below 5% (elite under 2%), days in A/R under 40, net collection rate above 95%, and cost to collect 3 to 5%. The scorecard prints these inline on the KPI comparison page.
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Score your operation in ten minutes. Get a clear picture of which architectural gap is costing you most. Direct download as soon as you enter your email.
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