Revenue Risk Assessment
One assessment quantifies exactly how much revenue is structurally at risk, where it's coming from, and how your facility compares to state peers and active federal audit targets — before you sign up for anything ongoing.
Eight analytical layers, built from CMS public data and your facility's own records — not a generic checklist with a price tag attached.
A point estimate plus an internal 90% interval around that estimate, so you see both the size of the exposure and how certain the model is — not a licensed actuarial opinion or a published statistical CI.
Built from PEPPER data — the same percentile benchmarking CMS's own contractors use — across therapy utilization, length of stay, readmissions, NTA frequency, and PDPM assessment patterns.
A missing Section GG score isn't valued the same as a missing diet order. Each gap type carries a PDPM Impact Multiplier, because one missed data point can shift a resident's entire classification for the full payment period.
A dedicated breakout for podiatry, dentistry, and optometry consults — referral-based orders that rarely flow through your primary physician queue, and consistently your highest-yield gap category.
Every gap category is checked by name against currently published federal audit targets, so you know which exposures carry materially higher real-world risk right now — not generically.
Risk weighting adjusts to your own payer mix and OIG target matches. Two facilities with identical dollar gaps can land at different risk scores depending on their census and audit-target profile.
If your CMI runs below the state average, every Part A day is paid below what your resident acuity justifies — a recurring quarterly loss, calculated separately from individual documentation gaps.
A credibility-weighted expected-loss estimate informed by actuarial methods — loss history, exposure base, frequency/severity trend, blended against peer/class averages. This is an internal analytical estimate, not a licensed actuarial opinion.
Synthetic illustration — not a real facility result
Synthetic illustration for a hypothetical 100-bed, 3-Star facility. Your dashboard, if purchased, reflects your facility’s own data. These figures are not a performance guarantee.
Most SNF compliance reviews stop at documentation gaps. This optional add-on goes further as an internal estimate — not a licensed actuarial opinion.
Most of this data doesn't exist in a typical SNF compliance audit — sourcing it is itself a differentiator. We request and structure:
We send a structured intake covering CMS public data, facility records, and (if requested) loss history. Most items are pulled from sources you already have.
Your numbers are run against state PEPPER percentiles, OIG Work Plan targets, and peer facility exposure data.
Risk weights adjust to your specific payer mix and audit-target profile — not a generic template score.
Delivered only to you, with a clear path to fix what's found before anyone else asks.
One-time assessment, priced by certified bed count — same tiers as RevOptix1 and our expert focus tracks.
Slide to your certified bed count — your one-time price updates instantly.
76–150 beds
$2,500
one-time assessment
All tiers
Optional actuarial-informed internal estimate (Section D) available as an add-on — scope and pricing confirmed during intake based on data availability. Educational service — not legal, financial, or actuarial advice; not a substitute for a licensed actuary’s formal opinion. A BAA alone does not constitute complete HIPAA compliance.
The assessment is an internal analytical estimate. It is not a licensed actuarial opinion, audit conclusion, or CMS finding.
Inputs typically include CMS public files (PEPPER, OIG Work Plan categories current at intake), facility-supplied claims/MDS extracts, and optional loss-run history. Exact vintage is stated on the delivered report because public files update on CMS/OIG calendars.
Exposure is estimated from PDPM-weighted documentation-gap categories plus, where available, case-mix vs state-peer gaps. The “90% confidence interval” is an internal interval around that estimate (normal approximation on blended category totals unless the report specifies another method). It is not a frequentist clinical-trial CI and is not independently validated as a published statistical model.
Not a guarantee of recoupment, recovery, survey outcome, or insurance pricing. PEPPER peer comparisons depend on the latest available CMS release for the facility’s state. OIG Work Plan matches use publicly listed categories at the time of analysis. No qualified actuary is identified as responsible for the public dashboard illustration.
The $56,784 / 62 / 2-category dashboard on this page is a synthetic illustration. Live assessments are not a SOC 2 report, penetration-test certificate, or HIPAA certification. Customers remain responsible for their own compliance program.