Where this started
In 2019, a multi-site pain management organization in Tampa, Florida was trying to understand why surgical cancellations were running high and which operational issues were affecting procedural volume.
Answering that question required connecting scheduling, surgical, and supporting operational records into a clearer view of the scheduled-to-performed funnel. Leadership needed to see not only that cancellations were happening, but where they were happening and what appeared to be driving them.
The work also expanded into revenue integrity. Contracted allowed amounts were compared against actual payments so leadership could see reimbursement gaps that had not been visible through normal reporting.
That same pattern now defines Prexisio’s focus: helping procedural practices identify leakage across denials, underpayments, and cancellation-driven revenue loss.
30%
Cancellation rate at engagement start
<10%
Leadership target for surgical cancellations
$2M+
Underpayment gap identified through contract review
The pattern we kept seeing
The data exists
Most practices already have the data needed to understand leakage. Claims, payments, scheduling records, authorization context, and operational files are already being produced.
The answers are fragmented
Denials, payments, and scheduling activity are often reviewed separately. Leadership can see pieces of the issue, but not the full revenue integrity picture.
The next step is unclear
Leadership may know revenue is leaking, but still not know where the problem is concentrated, why it is happening, or what to do next.
The same visibility gap in GI
A PE-backed GI management services organization needed unified reporting across acquired practices with different systems, payer mixes, and operating histories. The work created a recurring reporting layer across the organization and supported annual MIPS submission.
The gap we exist to fill
Most practices already have billing systems, scheduling tools, EHR reports, and advisors. The gap is turning disconnected data into clear revenue integrity answers.
RCM vendors
RCM vendors are important operating partners, but they are often working the issue after leakage has already appeared. Leadership still needs to know which denial, payment, and scheduling patterns are recurring and financially meaningful.
EHR and billing reports
Single-system reporting can show what happened inside one platform. It often does not connect claims, payments, scheduling activity, authorization context, and operational patterns into one revenue integrity view.
Consultants
Consultants can identify broad improvement areas, but practices still need a recurring way to turn their own data into specific leakage visibility and practical next steps.
What we believe
Revenue leakage is usually not invisible because the practice lacks data. It is invisible because the relevant data is fragmented across claims, payments, scheduling activity, payer behavior, and operational context.
Practices do not need another dashboard to manage. They need a clear explanation of where revenue integrity is breaking down and what deserves attention first.
The goal is not more reporting. The goal is clearer answers.
The principles we operate by
Client-specific beats generic
Revenue leakage looks different by specialty, payer mix, procedure mix, location structure, and operating model. Useful findings need to come from the practice’s own data.
Action matters more than reporting
The value is not another dashboard. The value is knowing where leakage appears concentrated and which revenue integrity actions leadership should consider first.
Denials, payments, and scheduling belong together
Preventable denials, underpayments, and cancellation-driven revenue loss are connected revenue integrity problems, not isolated reports.
Delivery should not create more work
Leadership should be able to read the summary in the inbox, go deeper when needed, and avoid managing another software workflow.
What we will not do
- Ask the client to manage another dashboard just to get value
- Present generic healthcare analytics as client-specific revenue intelligence
- Suggest confirmed leakage before reviewing the practice’s actual data
- Guarantee recovery, payer repayment, denial elimination, or cancellation elimination
Who this is for
Procedural practices where revenue integrity depends on more than one system, more than one payer, and more than one operational workflow.
Procedural specialty practices
Practices where claims, payments, scheduling activity, and procedural capacity all affect revenue integrity.
Multi-site and growth-oriented groups
Organizations where leadership needs visibility across providers, locations, payers, procedures, and operating patterns without building the full analytics layer internally.
A simple managed process
The client provides the data. Prexisio does the analytical work. Leadership receives clear findings and revenue integrity actions to consider.
Step 1
Assess
Start with the revenue leakage questions that matter most: preventable denials, underpayments, cancellation-driven revenue loss, and the visibility gaps around them.
Step 2
Analyze
The practice provides claims and scheduling data. Prexisio does the analytical work to identify where leakage appears concentrated and what leadership should examine first.
Step 3
Deliver
Leadership receives clear findings and revenue integrity actions in the inbox, with secure portal access available when the team wants to go deeper.
Start with a preliminary leakage profile.Clear answers on what to examine first.
The Revenue Leakage Assessment helps your team see whether the first area to examine is denial leakage, underpayment exposure, cancellation impact, or a broader visibility gap.