UB-04, DRG, observation, transfer. The full hospital stack.
Inpatient, outpatient, ED, observation, and facility billing under one program lead. Senior partners on this bench have run hospital billing departments inside 4-hospital systems. not consulted to them. We talk to your CFO in their language.
per senior
Six functions that decide your net collection rate.
Hospital billing has its own physics. The vendors who treat it like physician billing “at scale” lose money on transfer DRGs, two-midnight conversions, and observation. Here’s what we run differently.
UB-04 / 837I institutional billing
Inpatient, outpatient, ED, OBS, ambulatory surgery. Revenue-code-driven editing, condition-code discipline, occurrence/value-code capture. the institutional details payer scrubbers actually look at.
MS-DRG & APR-DRG optimization
Coding accuracy on the lines that move CMI: sepsis, AKI, malnutrition, respiratory failure, encephalopathy. CDI rounds embedded with the inpatient bench, not in a separate silo.
Two-midnight rule & observation discipline
Status determination is where hospital revenue gets quietly destroyed. We work the UR / case-management workflow with your physician advisor. and we keep the documentation defensible.
Transfer DRG & post-acute capture
Transfer DRGs are the highest-volume audit lane and the most overlooked revenue lane. We track every qualifying transfer and reconcile post-acute placements, so you bill the right amount and survive the audit.
ED facility & pro-fee split
ED billing is two cycles, not one. Facility leveling, pro-fee leveling, and the documentation that supports both. We staff dedicated ED coders. not floor coders pulled in.
RAC & payer audit defense
Hospitals get audited. We staff appeal lifecycle through ALJ, with senior coding + clinical review on every dollar over the high-dollar threshold. We track timeline like our license depends on it.
Six places hospital revenue typically leaks.
Below is what we see on the average hospital diagnostic. Not headline anecdotes. the structural leaks that show up across most engagements.
Status mis-billing
Two-midnight calls without supporting documentation. OBS billed where IP was warranted, or vice versa. RAC magnet.
Transfer-DRG miss
Eligible transfers not flagged at discharge. Per-diem reduction missed in the billing. or worse, billed full and clawed back.
CDI in a silo
CDI specialists run on retrospective queries instead of concurrent rounds. CMI sits below documentation potential.
ED leveling drift
Facility leveling and pro-fee leveling out of sync. Critical-care time mis-coded. Documentation gaps unaddressed.
Underpayment blindness
Payer paying below contract, undetected. No variance tracking against contracted allowable. Money left on the table monthly.
DNFB drift
Discharged-not-final-billed days creep without leadership visibility. Revenue stuck in pre-bill, not in AR. invisible to the dashboard.
Five phases. Same partner, start to finish.
A predictable rhythm. Same senior hospital partner from baseline to steady state. Your CFO gets the same person at every QBR.
Baseline & CMI read
90 days of remits, AR, CMI trend, denials, and DNFB read. Baseline KPIs locked in writing.
Bench & CDI stand-up
Inpatient, OP, and ED benches assigned. CDI specialists embedded. Edit library loaded.
Cutover & first close
First month of billing under our team. DNFB, CMI, denial trends reviewed weekly with revenue cycle leadership.
First CFO scorecard
4-page CFO scorecard with line-by-line variance explanation. Senior partner attends.
External audit + QBR
Third-party coding audit (100+ charts). Senior partner walks scorecard with CFO and physician leadership.
Six SLAs. Hospital-specific.
Generic RCM SLAs don’t map to hospital revenue. These do.
| METRIC | TARGET | WHY IT MATTERS |
|---|---|---|
| Clean-claim rate (837I) | 95%+ | Institutional clean-claim rate, by payer. Tracked daily, reported monthly. |
| DNFB days | < 4 days | Discharged-not-final-billed cycle time. Revenue stuck pre-bill is revenue invisible to AR aging. |
| CMI lift | +2-5% | Documentation-attributable case-mix index movement. Specialty-adjusted, not volume-driven. |
| Initial denial rate | < 5% | By payer and root cause. Top-5 causes flagged in monthly QBR with prevention plan. |
| Days in AR (dollar-weighted) | 38-45 | Hospital-typical range. Calculated weekly, audited quarterly to bank deposits. |
| Audit overturn | 60%+ | RAC / commercial post-pay overturn rate, dollar-weighted. Senior partner reviews high-dollar lanes. |
Senior partners who’ve run hospital billing. not consulted to it.
Every senior partner on the hospital bench has run a hospital or system billing department as the operator. They’ve closed the month, sat with the CFO when the AR aged badly, and explained to a board why DNFB drifted. The reports look different when the writer has been on your side of the table.
Operating depth, not org-chart depth.
- Same partner at every QBR. 12-month memory of your account, not a fresh face per quarter.
- CFO conversation. net revenue, contractual reserves, accruals, board-level KPIs.
- Physician conversation. CDI coaching, documentation specifics, MD-level CMI trends.
- Compliance conversation. RAC posture, audit pipeline, DRG-validation defense.
- Embedded CDI. concurrent rounds with med-surg and ICU, not retrospective queries.
Four CFO-grade monthly outcomes.
Get a free DRG & DNFB read.
Send us your last 90 days of inpatient remits + DNFB report. We’ll send back a 4-page diagnostic on CMI, DNFB drift, transfer-DRG exposure, and audit risk. No obligation.
Pick a slot. No SDR triage.
Talk to a senior ASP-RCM partner about your hospital RCM. 30 minutes. Bring your denial reports, your DRG mismatch rate, or your appeal backlog. We will walk through where the systemic leaks are.
30 minutes with a senior partner.
Free. Same calendar a senior partner and directors live in. The next available slots are below.