TrustedRCM Revenue Recovery Audit™

Practice & Contact Information

Practice Name *

Legal Entity Name *

Primary Specialty *

Practice Website

Primary Contact for This Audit

Full Name *

Role/Title

Email Address *

Phone *

Preferred Communication Method *EmailPhoneEither is Fine

Practice Profile & Payer Mix

These questions help us calibrate benchmarks and recommendations to your size and specialty.

Number of Providers (MD/DO/NP/PA) *

Payer Mix (rough percentages – best estimate is fine)(numbers, should total ~100%)

NumberMedicare: [ ] %

Medicaid: [ ] %

Commercial: [ ] %

Self-pay / Other: [ ] %

States Where You Currently See Patients

Current Billing Setup

We use this to understand how your revenue cycle is structured today and where responsibility sits.

How is your billing currently handled?Entirely in-houseFully outsourcedHybrid (some in-house, some outsourced)

What billing / practice management system(s) do you currently use?

Who is primarily responsible for each of the following?

Eligibility & benefits verification

Charge capture / encounter documentation

Charge entry & claim submission

Denial management & appeals

Patient statements & collections

Do you currently track any key billing KPIs (e.g., AR days, denial rate, collection rate)?

Pain Points & Goals

This helps us prioritize our analysis and recommendations around what matters most to you.

What are your top 2–3 frustrations with your current billing and collections?

If you could change one thing about your billing process in the next 90 days, what would it be?

How would you describe your current cash flow situation?Stable and predictableGenerally okay, but with occasional spikes/dipsFrequently tight or unpredictable

Compliance & Risk (High-Level)

We are not performing a full HIPAA audit, but we do look for revenue-impacting compliance risks.

Do you have written workflows or checklists for front desk, billing, and follow-up?YesPartiallyNot really

Briefly describe how denied claims are currently handled.

How often does someone review AR aging reports and take action on 60+ day balances?WeeklyMonthlyOccasionally / as time allowsRarely

Are there any specific payers or services you feel are consistently problematic (slow pay, frequent denials, underpayments)?

What are your main goals for this audit?Identify where money is being left on the tableReduce denialsShorten AR days / improve cash flowEvaluate whether to outsource billingValidate current billing performance with an independent review

Compliance & Risk (High-Level)

We are not performing a full HIPAA audit, but we do look for revenue-impacting compliance risks.

Do all staff who access billing/PHI have unique logins to your systems?YesNoNot Sure

Do you provide regular (at least annual) training on documentation and billing compliance?YesNoInconsistently

Have you had any payer audits, recoupments, or significant compliance issues in the last 2–3 years?YesNo

Upload Your Reports

These reports allow us to quantify your AR, denial patterns, and revenue opportunities using your own data. If you’re unsure how to pull a specific report, you can pause here and forward this page to your billing lead or IT contact.

AR Aging Report *Type: Accounts Receivable Aging Date: 3-6months Detail: By aging bucket (0–30, 31–60, 61–90, 91–120, 120+), ideally by payer Format: PDF or Excel/CSV

No file chosen

Denial Report *Type: Denials by reason and payer Date range: Last 3–6 months Detail: Denial reason code & description, payer, count and/or dollar amount Format: PDF or Excel/CSV

No file chosen

Zero-Pay / Underpayment ReportType: Top procedures/services by volume and revenue Date range: Last 3–6 months Detail: CPT/HCPCS code, number of units/visits, total charges and payments (if available) Format: PDF or Excel/CSV

No file chosen

Top CPT Codes / Services Report *Type: Top procedures/services by volume and revenue Date range: Last 3–6 months Detail: CPT/HCPCS code, number of units/visits, total charges and payments (if available) Format: PDF or Excel/CSV

No file chosen

Internal Dashboards or Summary ReportsAny AR, denial, or collection dashboards you already use.

No file chosen

Additional Notes for Our Team

Review & Submit

Once you submit this form and upload your reports, we’ll begin your TrustedRCM Revenue Recovery Audit™. Our standard turnaround time is up to 14 days from the time we receive all requested information.

Checkbox (required):I confirm that the information provided is accurate to the best of my knowledge and that I am authorized to share these reports for the purpose of this audit.

TrustedRCM Revenue Recovery Audit™ – Secure Intake & Upload