Afrexai Medical Billing

Revenue Cycle KPIs

Payer Contract Analysis

• Fee schedule comparison: Medicare vs commercial rates by CPT
• Allowed amount benchmarking (what you should be getting paid)
• Underpayment detection: compare ERA/835 to contracted rates
• Rate negotiation prep: volume data, market rates, quality metrics

Compliance & Audit Readiness

• OIG Work Plan items relevant to your specialty
• Stark Law / Anti-Kickback safe harbors checklist
• False Claims Act risk factors
• Internal audit sampling methodology (statistically valid)
• Documentation improvement programs (CDI)

Charge Capture Optimization

• Missed charge identification by department
• Charge lag analysis (days from service to charge entry)
• Superbill/encounter form design best practices
• Common missed revenue: vaccines, injections, supplies, time-based codes

Patient Financial Responsibility

• Eligibility verification workflow (real-time vs batch)
• Prior authorization tracking and requirements by payer
• Patient estimate generation (good faith estimate compliance)
• Collections strategy: statements → calls → agency threshold
• No Surprises Act compliance checklist

Usage

Give the agent your:

• Specialty (orthopedics, cardiology, primary care, etc.)
• Payer mix (% Medicare, Medicaid, commercial, self-pay)
• Current KPIs (denial rate, days in A/R, collection rate)
• Problem area (denials, underpayments, coding, compliance)

The agent will analyze against benchmarks and give specific, actionable recommendations.

Example Prompts

• "Our orthopedic practice has a 12% denial rate. Top reasons are CO-4 and CO-16. Analyze root causes."
• "Compare our cardiology fee schedule to Medicare rates for our top 20 CPTs."
• "Build an appeal letter for a CO-197 denial on CPT 99214 with modifier 25."
• "Audit our E/M coding distribution — we're billing 80% level 3. Is that normal for family medicine?"
• "Our days in A/R jumped from 32 to 48 in two months. What should we investigate?"

Industry Context

Medical billing errors cost US healthcare $935 million per week. The average practice loses 5-10% of revenue to preventable billing issues. Denial management alone can recover 2-5% of net revenue when done right.

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