Revenue infrastructure for behavioral health & orthopedics
Protect the revenue your practice has already earned.
ClaiMed finds the revenue-cycle problems that delay or cost your practice money. We investigate what happened, own the problem, and stay with it until it’s resolved.
Protect Revenue. Build Systems. Earn Trust.
NO COST · NO OBLIGATION · WE REVIEW YOUR LAST 90 DAYS OF CLAIMS
DAYS IN A/R
44 → 20
TIME TO PAYMENT
34 → 17
ZERO-PAY CLAIMS
Resolved
“I can’t get a straight answer.” Reports arrive, but nobody explains what changed.
“Money is missing and I can’t prove it.” Collections dipped months ago; the cause was never found.
“Everything is an excuse.” Denials get blamed on payers, the EHR, the front desk.
Revenue Leak Diagnostics
How revenue goes missing.
Most losses are small enough per claim to go unquestioned, and they repeat for months before the pattern is visible in a monthly report. These are the six we check first.
LEAK 01
Claims that never arrived
Batches stop at the practice management system and never reach the clearinghouse. After a billing transition we have found hundreds sitting unsubmitted, with nothing in the reporting to indicate they were missing.
LEAK 02
Automatic downcoding
A payer pays a lower level of service than the one billed, without issuing a denial. The difference on a single claim is small enough to ignore. Across six months of volume it becomes significant.
LEAK 03
Line-level underpayments
One line of a claim is paid and another is skipped. The remaining balance is usually written off unless someone reads the remittance line by line.
LEAK 04
Structural A/R aging
Medicaid eligibility in behavioral health, and authorization and global-period disputes in orthopedics, routinely push A/R past 90 days. The volume is predictable, so the work has to be staffed for rather than absorbed.
LEAK 05
Denials with no root cause
A claim is rebilled, denied again, and rebilled again, without anyone asking whether the payer processed it correctly the first time.
LEAK 06
Credentialing gaps
A new clinician or surgeon begins seeing patients before enrollment takes effect. That revenue is frequently recoverable, provided someone identifies the gap while the filing window is still open.
The ClaiMed Revenue Resolution System™
Five steps we run on every revenue problem.
Most billing relationships stop after the first step. Ours continues through all five, so responsibility for a revenue problem sits with the company rather than with whoever answers the phone.
01
Identify
Monitor the cycle closely enough that a change in the numbers surfaces within weeks.
02
Investigate
Establish the root cause, whether it is coding, eligibility, enrollment, the system, the payer, or a workflow upstream of billing.
03
Own
The problem becomes ours to carry and ours to report on. You receive current status on it until it is closed.
04
Resolve
Work it to a conclusion: corrected, appealed, reprocessed, recovered, or documented as uncollectable with the reason stated.
05
Prevent
Agree what has to change so the same leak does not reopen, and state clearly which part of that belongs to us and which belongs to your team.
Recover · Protect · Grow
Three jobs, in sequence.
We start with recovery, because unpaid earned revenue is the fastest money to reach. Protection follows, so the same losses stop recurring. Growth work comes last, once the cycle is stable enough to plan against.
Recover
Collect revenue the practice has already earned.
→ A/R cleanup and aged claim recovery
→ Denial investigation and appeals
→ Underpayment and downcoding review
→ Cleanup after a previous billing company
Protect
Stop the same losses from recurring.
→ Full-cycle claim submission and scrubbing
→ Eligibility, benefits and authorizations
→ Credentialing and payer enrollment
→ Monthly review of what changed and why
Grow
Give leadership the numbers to make decisions with.
→ Revenue reporting written for owners
→ Payer mix and reimbursement analysis
→ Revenue modeling for new providers and sites
→ Oversight for practices keeping billing in-house
Visibility
You should hear that revenue is slipping from us, before you see it in the bank balance.
Each month we go through your numbers with you: what changed, where you stand, what we did about it, and what needs attention. You shouldn’t have to chase us for answers or wonder what’s happening with your revenue.
That’s what peace of mind about your revenue cycle looks like.
→ A named contact who knows your practice and answers the phone.
→ Written follow-through on every open revenue problem.
→ Clear division of what we are responsible for and what your team is.
DAYS IN A/R · MONTHLY
TARGET 25
M1
M2
M3
M4
M5
M6
Illustrative shape of a turnaround engagement. Your diagnostic establishes your actual baseline.
Where we’re deepest
Two specialties, in depth.
Behavioral health and orthopedics each have their own payer behavior, coding rules and denial patterns. We built the practice around both because the specifics are where the recoverable money is.
BEHAVIORAL HEALTH
Psychiatry, therapy and counseling groups, SUD and IOP programs. Medicaid eligibility, session-based coding and clinician credentialing at volume.
ORTHOPEDICS
Surgical and sports medicine practices. Global periods, modifier accuracy, implant and DME billing, prior authorization and ASC coordination.
A turnaround engagement
A practice under operational stress, twelve months later.
Charge entry was running late, zero-pay claims were accumulating, and no one could explain why A/R kept aging. We rebuilt the process that produced the backlog instead of working it claim by claim.
Results from one multi-provider specialty practice. Practices differ, and we do not quote a figure before reviewing your data.
34 → 17
DAYS TO PAYMENT
44 → 20
DAYS IN A/R
Zero
UNRESOLVED ZERO-PAY CLAIMS
Down
DENIAL RATE, SUBSTANTIALLY
Asked why they stay, our clients name transparency, attention to detail and follow-through.
FROM OUR OWN CLIENT RESEARCH
Led by operators, not account managers
A decade inside orthopedic revenue cycle work, a behavioral health book built alongside it, and a background in systems and process design. The owners review the work.
Full service or oversight only
We take on the full cycle, or provide oversight and revenue reporting for practices that keep billing in-house.
Find out where your revenue is getting stuck.
Request a Revenue Diagnostic
A few details about your practice. Within two business days we will come back with what we would examine first, or tell you directly if we are not the right fit.
ClaiMed Solutions protects the revenue healthcare practices have already earned. We find revenue leaks, resolve the problems behind them, and build systems that help prevent them from happening again.
Protect Revenue. Build Systems. Earn Trust.