Your Health, Our Mission
Compassionate care, expert RCM solutions — for every stage of life and revenue management.
care strategy and payer contract advisory services to IPAs, large medical groups, and health systems.
Our work spans:
• Payer Contract Renegotiation — We analyze rate structures, risk corridors, and quality incentive terms to position provider organizations competitively as market conditions shift
• Medicare Advantage Strategy — From network configuration to risk adjustment optimization, we help organizations build durable MA revenue in an increasingly competitive landscape
• Value-Based Care Performance — We assess VBC program architecture, attribution logic, and shared savings infrastructure to ensure performance metrics align with your organizational capabilities
• Payment Integrity & Compliance Advisory — In an environment of shrinking reimbursement and heightened audit activity, payment integrity is not optional — it is a margin protection strategy
• Medicaid Managed Care Navigation — We help provider organizations understand the downstream payer contract implications of enrollment disruption and prepare for the financial impact before it arrives
RCM Optimization Results — Physician Group & IPA
Capturing Every Dollar Across a
High-Complexity Payer Portfolio
Medicare Advantage Contract Realignment · HCC / Risk Adjustment Optimization · Denial Reduction & Authorization Redesign
12-Month Net Revenue Gain
Driven by MA contract renegotiation, HCC gap closure, and full-cycle RCM optimization across a $152.7M multi-payer portfolio spanning 180 physicians and 12 practice sites.
Revenue Leakage Recovery
$26.6M returned to net revenue by eliminating preventable leakage
Across six leakage categories — HCC/risk adjustment gaps, MA contract underpayments, claim denials, authorization failures, charge capture losses, and eligibility/COB failures — annual leakage fell from $38.4M to $11.8M over the engagement, a 69% reduction.
Payer Mix & Contract Intelligence
Portfolio Composition — $152.7M
Denial Rate by Payer — Engagement Impact
| Payer | Prior Rate | Current | Reduction |
|---|---|---|---|
| Medicare Advantage | 18.6% | 7.4% | ↓ 60% |
| Commercial PPO | 11.3% | 4.8% | ↓ 58% |
| Medicare FFS | 6.2% | 2.9% | ↓ 53% |
| Medicaid MCO | 16.8% | 6.9% | ↓ 59% |
| Commercial HMO | 9.7% | 4.1% | ↓ 58% |
12-Month Operational Outcomes
12-Month Performance Trajectory
Days in A/R & claim denial rate with gradient trend areas and milestone callouts
HCC Risk Capture & RAF Score Optimization
Prospective and retrospective HCC coding programs under CMS V28 HCC model standards drove a 27-point RAF score improvement, directly increasing Medicare Advantage capitation revenue and shared savings distributions.
RAF Score Growth & HCC Capture — Monthly Lollipop Progression
Lollipop stems show RAF score above baseline · HCC capture bars below · January – December 2025
Revenue Leakage — Waterfall Analysis
Cascade Recovery — Annual Leakage Waterfall
Each gold bar shows amount recovered per category · Floating from prior level to new level · In $M
A/R Aging Distribution
Receivables concentration in the 0–30 day bucket grew from 47% to 68%, while 120+ day exposure was reduced from 3% to 1%, eliminating substantial write-off exposure.
A/R Aging — Before vs. After Diverging Comparison
Bars extend outward from center · Muted = Prior State · Gold = Current State · % of Total A/R
Denial Rate Performance by Payer
MA-specific denial reduction was the highest-priority initiative — authorization redesign, NCQA-compliant UM criteria (42 CFR Part 422), and real-time eligibility verification drove a 60% MA denial reduction.
Claim Denial Rate — Dumbbell Before / After by Payer
Muted circle = Prior Rate · Gold circle = Current Rate · Line shows magnitude of reduction
MA Contract Rate Improvements — Key Benchmarks
Renegotiated Medicare Advantage agreements and value-based addenda drove direct rate improvements across the group’s primary contracted payers.
Regulatory & Compliance Performance
Engagement Return on Investment
Your physician group may be leaving
significant revenue uncaptured.
CMS1 Partners™ brings 20+ years of payer-side and provider-side expertise to your MA contract optimization, HCC risk capture, and full-cycle RCM performance — with measurable, documented results.
Optimize My Revenue CycleNo obligation · U.S. Based & National Reach · IPA · Medical Group · MSO
