Sample RCM Audit | Executive Revenue Analysis Example

1

You send one export

Aging report, denial report or claim dump — straight from your billing software.

2

We run the diagnostics

KPIs, AR aging, payer yield, denial forensics, backlog and benchmark scoring.

3

You get the action plan

Every leak ranked by recoverable dollars, with the fixes sequenced.

4

We recover it (optional)

Bring us in for recovery at 5% of collections or 15% contingency on old AR.

Figures below are from a real, de-identified client engagement — shown with permission. They reflect that practice's performance at audit time, not Zaxis benchmarks.

Section 1 · Executive KPI Dashboard

The Financial Baseline in One View

Total billed, collected revenue, adjustments and open AR — with collection ratios measured against benchmark.

Total Billed$356,2082,603 CPT claim lines

Collected Revenue$118,554Gross collection rate: 33.3%

Net Collection Rate77.7%Benchmark ≥ 95% — critical gap

Outstanding A/R$79,93622.4% of total billed

Section 2 · A/R Aging & Timely Filing Risk

82.4% of Open A/R Sits Past 151 Days

Aging buckets reveal timely-filing windows closing fast — $65,896 in the high-risk zone.

61–90 days

$654 · 0.8%

91–120 days

$2,586 · 3.2%

121–150 days

$10,800 · 13.5%

151–180 days

$14,437 · 18.1%

181–360 days

$47,722 · 59.7%

360+ days

$3,737 · 4.7%

Section 3 · Payer Performance Matrix

Which Payers Pay — and Which Don't

Charges, collections and net collection rate by payer family. Medicaid at 22.9% GCR was the worst yield in this portfolio.

Payer	Claims	Billed	Collected	GCR
Medicare	414	$83,942	$26,724	31.8%
Other Commercial	385	$78,346	$29,317	37.4%
BCBS	312	$64,507	$25,218	39.1%
Medicaid	175	$34,061	$7,785	22.9%
Aetna	149	$31,845	$11,694	36.7%
Cigna	112	$23,253	$7,919	34.1%

Sections 4–5 · Risk Model & Denial Forensics

$25,423 at Risk. 349 Denied Lines.

Expected-recovery modeling meets CARC-level denial diagnostics.

Collectible Allowed

$40,221

Ceiling from $79.9K open A/R

Expected Recovery

$14,798

Base case at 36.8% collection factor

Revenue at Risk

$25,423

63.2% at risk of write-off

Denial categories by denied charges

Authorization / OON

$9,454 · 55 lines

Non-covered charges

$9,193 · 60 lines

Timely filing expired

$7,196 · 47 lines

Duplicate claim

$7,058 · 47 lines

Eligibility issues

$4,250 · 32 lines

Provider not certified

$3,183 · 20 lines

Coding issues

$2,576 · 20 lines

Top denial driver: CARC CO-197 (pre-cert missing). Missing precertification and intake eligibility verification caused 23% of preventable cash-flow delays.

Sections 6–10 · Backlog, Yield, Benchmarks, Plan

From Diagnosis to Action Plan

Every audit closes with backlog triage, CPT yield, benchmark scoring and a sequenced recovery plan.

$30,101 Unbilled Backlog

214 claim lines trapped in pre-bill queues — 66% aged over 180 days. Immediate cash recovery upon submission.

Queue	Lines	Amount
Pending bill	53	$7,820
Ready to bill	62	$7,582
Unbilled / hold	48	$7,563
Charge hold	51	$7,136

KPI Scorecard vs MGMA Benchmarks

KPI	Actual	Benchmark	Status
Net collection rate	77.7%	≥ 95%	Critical gap
Days in A/R	78.8	≤ 45	Above target
A/R over 90 days	99.2%	≤ 25%	Above target
Denial rate	13.4%	≤ 10%	Above target
Write-off %	6.9%	≤ 5%	Moderate