Specialty Groups
High-dollar procedures mean high-dollar denials. The math is bigger in your world.
When the average claim is a procedure, an implant, or an infusion, a single denial can equal a family practice's entire week of denied revenue. Specialty groups don't have a denial-rate problem; they have a denial-severity problem.
You, Specifically
Your revenue concentrates in a small number of high-value CPT codes, which is exactly where payers concentrate their medical-necessity reviews, prior-auth requirements, and downcoding algorithms. One denied procedure isn't a statistic; it's a hole in the month.
And the prior-auth treadmill never stops: your clinicians and staff burn hours per week feeding payer portals for care that's ultimately delivered anyway. Then a percentage of it still comes back denied on a technicality.
The Patterns
The denials we see in your world, over and over.
- Medical-necessity denials on your highest-value procedures
- Prior-auth denials where the auth exists but numbers, dates, or units don't match
- Downcoding and bundling edits that shave hundreds per case
- Medicare Advantage plans denying at rates traditional Medicare never did
- Implant and invoice-based reimbursement disputes
The Engagement
What working with us looks like.
01
Audit prioritizes your top CPT codes by denied dollars, not claim counts.
02
Clinical documentation review on medical-necessity appeals, argued in clinical terms.
03
Contract-rate underpayment audit across your top payers, procedure by procedure.
04
Monthly root-cause reporting tuned to your specialty's denial taxonomy.
Pricing
High average claim values make the contingency math work strongly in your favor, and make the flat-rate program a rounding error against one recovered procedure. Both models on the Pricing page.
See both pricing models →Sound like your practice?
15 minutes, a real person, no pitch deck. Or skip the call and sign up online. Prefer to dial? (479) 274-0716
Know your number before you sign anything.
The Recovery Audit is a $500 analysis, yours free, in writing, with an honest go/no-go. Limited slots each month.
Sources
- 1.Physicians and staff spend an average of 13 hours per week on prior authorization tasks. AMA 2024 Prior Authorization Report
- 2.The average denied Medicare Advantage claim is now worth about $1,000, up 22.4% year over year. MDaudit network data, 2025
- 3.Of denied Medicare Advantage claims that ARE appealed, roughly 54–57% get overturned. Federal MA appeals data / KFF