Revenue Intelligence

Find out where the money actually went.

Executive dashboards and RCM analytics that show what happened, why, and what to change.

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Intelligence investigationOne fictional practice, one monthSample investigation

Billed

$486,200

Adjusted

$171,400

Contractual

Allowed

$314,800

Where the allowed amount went

CollectedPayer and patient payments posted$245,700
Other adjustmentsPosted after adjudication, each with a reason$12,600
OutstandingPayer and patient balances still open$29,500
DeniedDenied and not yet resolved$19,700
Unexplained varianceNo posted activity accounts for it yet$7,300

Allowed = collected + other adjustments + outstanding + denied + unexplained variance.

Start with the number
Open the claims
Match the remittances
Name the cause

Expected amounts rely on verified contract or fee-schedule data where it is available. Without it, a difference is flagged for verification, not called an underpayment.

Illustrative figures for a fictional practice. Not a Kitronixe client result.

Three questions. This page answers the first.

Revenue IntelligenceYou are hereWhere did the money go, and why?Trace revenue movement, leakage and its financial root causes.
Practice AnalyticsHow is the practice operating?See provider, patient-access, location and operational performance.
RCM AuditIs the revenue cycle working the way it should?Test workflows, document findings and prioritize remediation.

The question

Where did the money go, and why?

A practice can know what it collected and still not know what it missed. The gap between the two is made of individual claims, and each one has a reason.

Reporting that describes the past is common. Reporting that changes what happens next is rarer, and is the point of measuring at all.

Follow the money

From billed charges down to the last unexplained dollar.

Every stage below removes part of what was billed, and each removal should have an explanation in the data. Choose a stage to see what supports it, what moves it, and what gets looked at.

Money traceOne fictional month - choose a stageIllustrative money trace

Stage 7 of 7

Denied / unresolved

−$27,000 · 19,700 denied, 7,300 unexplained

What data supports it: Denied lines with their reason groups, plus balances no posted activity accounts for.
What can cause movement: Authorization, eligibility, documentation requests, duplicate submissions and posting gaps.
What Kitronixe investigates: The pattern behind the denials, and the claims behind any balance nobody can yet explain.

Illustrative figures for one fictional practice and month: the stages account for every billed dollar, and the dashed outline is the contractual adjustment. Not a Kitronixe client result.

Claim to cash

One claim group, six places a balance can stall.

An example group of claims moving from submission to whatever is still open. Choose a stage to see what the balance looks like there.

Example claim group A24 claims · Payer A and Payer B · $38,400 billedIllustrative claim group

Where the group’s balance goes

Submission24 claims submitted

Claims leave the billing system and are accepted or rejected by the clearinghouse before a payer sees them.

$38,400 still open

Why does this balance still exist?

Choose an explanation to see the part of the remaining balance it accounts for.

Remaining A/R: $9,000

Denial

$2,600 of $9,000 · 2 claims

The payer refused one or more lines. The reason decides whether a correction, an appeal or a write-off is appropriate.

Illustrative claim group with payers shown as letters; no patient or payer is identified. A claim can carry more than one explanation, but each dollar is counted under one only. Not a Kitronixe client result.

From number to action

Start with a number. Finish with a work queue.

A figure on a report is where the investigation begins, not where it ends. Pick a scenario and drill down one step at a time.

Root-cause explorerChoose a scenario, then drill downIllustrative scenarios

Illustrative scenarios with invented counts and payers shown as letters. A real investigation can end at a different cause, or at no problem at all. Not a Kitronixe client result.

Twelve analytical views

Twelve views, each built to answer one question.

The views come in four groups. Each one exists because a practice leader asked a specific question about the money; the question is shown with it.

01
Executive dashboards
Days in A/R, denial rate, clean claim rate, net collection rate.
02
Denial trend analysis
By payer, code, provider and location.
03
Revenue leakage
Unbilled encounters, missed charges and charge lag.
04
Payer performance
How each payer actually behaves, rather than how the contract reads.

Findings, not charts

What a finding looks like before anyone acts on it.

Each finding carries its evidence, the part of the revenue cycle it touches, how far it has been verified, and who owns the next step. Not every finding is confirmed, and the board says so.

Findings boardFive findings at different stages of verificationSample findings board

Observed: Seen in the data, not yet checked against source records.
Needs verification: Needs a source, such as the current contract, before anyone acts.
Verified: Checked against the claims, remittances or contract behind it.
Action assigned: Verified enough to act on, with an owner and a queue.

Sample findings board: finding, evidence, financial area, verification state, recommended action, owner or queue, status
Finding	Evidence	Financial area	Verification state	Recommended action	Owner or queue	Status
Potential underpayment	58 Payer A remittances paid below the fee schedule on file for one service group	Payer payments	Needs verification	Confirm the current contract terms before anything is disputed	Underpayment review	Open
Denial concentration	46 denied claims sharing one reason group, Payer B, one location	Denials	Verified	Fix the upstream step; appeal where the documentation supports it	Denial work queue	In progress
Unbilled encounters	27 documented encounters with no charge attached after 7 days	Charge capture	Observed	Practice confirms which encounters are billable	Charge review (practice)	Open
Old A/R cluster	18 Payer C claims over 120 days with no recorded follow-up	Accounts receivable	Action assigned	Status check, then corrected claim or appeal where applicable	A/R follow-up queue	In progress
Posting variance	$3,420 deposited against 12 remittances not fully posted	Payment posting	Needs verification	Reconcile the deposit to each remittance line	Posting reconciliation	Open

Potential underpaymentNeeds verification
Payer payments
Evidence:
58 Payer A remittances paid below the fee schedule on file for one service group
Recommended action:
Confirm the current contract terms before anything is disputed
Owner or queue:
Underpayment review
Status:
Open
Denial concentrationVerified
Denials
Evidence:
46 denied claims sharing one reason group, Payer B, one location
Recommended action:
Fix the upstream step; appeal where the documentation supports it
Owner or queue:
Denial work queue
Status:
In progress
Unbilled encountersObserved
Charge capture
Evidence:
27 documented encounters with no charge attached after 7 days
Recommended action:
Practice confirms which encounters are billable
Owner or queue:
Charge review (practice)
Status:
Open
Old A/R clusterAction assigned
Accounts receivable
Evidence:
18 Payer C claims over 120 days with no recorded follow-up
Recommended action:
Status check, then corrected claim or appeal where applicable
Owner or queue:
A/R follow-up queue
Status:
In progress
Posting varianceNeeds verification
Payment posting
Evidence:
$3,420 deposited against 12 remittances not fully posted
Recommended action:
Reconcile the deposit to each remittance line
Owner or queue:
Posting reconciliation
Status:
Open

Sample findings with invented counts for a fictional practice. Not every finding is confirmed: a finding marked Observed or Needs verification is a question, not a conclusion. Not a Kitronixe client result.

The monthly view

One view of the money, read the same way every month.

Seven panels a finance lead reads in order: how revenue moved, how A/R moved, where denials concentrate, where payers vary, what can be pursued, what is unexplained and where the claims sit.

Sample revenue intelligence viewOne fictional practice, month sixIllustrative data

Revenue movement

BilledUp $14,300 on last month
Last month$471,900
This month$486,200
AllowedUp $8,500 on last month
Last month$306,300
This month$314,800
CollectedDown $5,500 on last month
Last month$251,200
This month$245,700

Sample revenue intelligence view: illustrative data for a fictional practice, with payers shown as letters. Not a Kitronixe client result, and not a benchmark.

Common questions

Answers for practice leaders and finance teams.

All FAQs

Do you work inside our existing systems?

Yes. Kitronixe works in your EHR and practice management system rather than requiring a migration. Your data stays where it is.

How long does a transition take?

It depends on volume and how many payers are involved. We transition in stages rather than all at once, so nothing stops while the changeover happens.

What do you report on?

Days in A/R, denial rate, clean claim rate and net collection rate, monthly and against an agreed baseline. If performance slips you will see it in a report before you hear it in a meeting.

Find out what your claims and remittances already say.

A review works from your own data and reports what it finds, including when the answer is that the cycle is running well.