Riverbend Pain · Demo LedgerDEMO · fictional practice · synthetic data

Overview — the 60-second read

Standing alerts

Owner's analysis

What changed since last build

Findings — machine-detected, every build

Deterministic rules over the cubes: benchmark breaches, spikes vs a payer's own history, underpayment candidates, concentration. These fire whether or not an authored analysis exists.

Outlier register

Money

Where every earned dollar went — YTD

Date-of-service basis, practice-wide (filters do not apply). Charges appear here only to anchor the waterfall.

How cohorts pay — payment velocity

Cumulative collections by months since service, each line one service month. Mature cohorts define the trajectory; young cohorts ride it upward.

Solid = mature (≥85% adjudicated). Dashed = still filling. Mature curves normalize to their own totals; young cohorts to a projected total = observed dollars ÷ the mature cohorts' completion fraction at the same age.

Net collection rate — mature months

Collections ÷ (charges − contractual write-off), by service month. Adjusted variant removes status-denied/rejected balances and the flagged legacy claim from the denominator.

Who pays you — payer mix

Collections composition, year to date, on the current basis and filters. Patient money shown as its own slice — it is real cash, not a payer.

Provider/site filters do not apply to this panel (payer totals shown at practice grain so names are not over-suppressed). Bars: monthly composition, 100% each month. Watch for drift toward slower payers (scorecard on the Stuck tab) and the patient slice growing with upfront collection.

Payer report card

Graded and ranked: each payer scored on Rate (mix-controlled % of Medicare, 50% weight), Speed (median days to pay, 25%), and Clean (admin write-offs as % of their collections, 25%) — the small letters are those three, in that order. Importance (collections + new-patient share) is deliberately kept out of the grade: how well they treat you and how much you need them are different questions. Tap any row for the full card. † $/wRVU includes patient share — realized allowed amount. Thresholds — Rate: A ≥110% of Medicare · B ≥95 · C ≥85 · D ≥75 · F below. Speed: A ≤14d · B ≤21 · C ≤30 · D ≤45 · F beyond. Clean: A <0.5% · B <1 · C <2 · D <4 · F ≥4%. Grades require ≥15 sessions; ~ marks a rate graded from the approximate (case-mix-blended) figure.

Allowed by code — what each contract actually pays

Charge minus the contractual write-off on paid lines = the payer's allowed amount, by code. Medians; cells need five or more paid claims. Colour is the payer's allowed as a share of Medicare's for the same code. E&M and procedures only; modifier-50 and add-on lines excluded.

Rate quality — $/wRVU vs Medicare

Mix-controlled: each payer compared to what traditional Medicare pays you for the same codes, session-weighted — the honest rate test. Yellow line = Medicare parity (100%). Raw $/wRVU shown for context only; it blends case mix and can mislead.

Collections-based: uncollected patient shares and immature claims deflate slow payers modestly.

Two personalities — E&M vs procedure rates

Each payer's rate measured separately inside visit codes and inside procedure codes, mix-controlled against Medicare within each class. A payer that underpays clinic work but pays procedures well is tolerable; one that underpays the procedures is the real contract problem.

≥10 sessions per class required. Red = below 95% of Medicare in that class.

The rate matrix — $/session, top codes × top payers

The table to bring to a negotiation. Cells under 5 sessions suppressed.

Worth keeping? — exit analysis

The economics of dropping a payer, stated plainly: with supplies ~13% of collections, almost any payer produces positive contribution on an otherwise-empty slot — in a growing practice, dropping payers mostly shrinks the pipeline. Exit makes sense only when a payer is well below Medicare and replaceable and expensive to collect from — or as leverage in renegotiation. Tags below are advisory; fee-schedule confirmation comes before any termination notice.
Tags — KEEP: ≥95% of Medicare rate or ≥8% of collections. REVIEW: <85% of Medicare, <5% of new patients, and <75 patients affected. Everything else WATCH. Structural notes override economics: UMR rides the UnitedHealthcare network (fight per-claim, not exit); WellMed/Humana are renegotiate-first (MA cycles annually); Medicare/Tricare are community anchors.

Medicare Advantage vs traditional

Fee-schedule socket armed: when contracted rates land in the CPT table, this tab gains a %-of-contract column and the underpayment radar upgrades from inference to recoverable variance.

Where every recent patient stands — the order funnel

Every patient who kept a visit in the last 90 days, placed in one state: on the books, waiting on an order that is moving, an order that has stalled, an order completed with nothing booked after it, or no order and nothing booked. Procedures count as done when a procedure was actually billed or entered, not when the order was closed.

Orders — open, moving, stalled

Orders by type and state. "Stalled" = open past the type's clock (procedures 21 days, everything else 30) with nothing scheduled or performed; "legacy" = placed before the orders workflow was in use and never closed. Tap a row for aging.

Forward schedule — booked against run rate

Visits on the book for the next eight weeks, by provider, against that provider's kept visits per week over the trailing eight. A short book is either how procedures are scheduled or a demand gap; the shape week to week says which.

Access and schedule quality

Trailing three months. Kept = checked out, checked in or arrived. Cancellations split by who caused them. Confirmation is measured by what it does to no-shows.

Kept visits by weekday and hour

Cancellation reasons

Bookings by scheduler — names are in the local worklists file

Money stuck — accounts receivable

Snapshot, aged from date of service. Practice-wide; provider and location filters do not apply.

Payer scorecard

One row per payer: what they pay, how fast, and what they cost you. Sorted by collections.

$/enc is date-of-service basis, all months. Days-to-pay = adjudication − service date on payer payments.

Cash on the way — forecast

Open insurance A/R converted to expected cash by when it should land, from each payer's observed payment timing at each claim's current age.

A/R over time

One point per monthly build. This chart earns its keep as history accrues.

Money given away — administrative write-offs

Non-contractual write-offs only. Owed and not collected. Preventable. Transfers to patient responsibility are not counted here.

By reason, over time

Denials — what payers are refusing, and how it ends

A claim counts as denied if any line is status Denied/Rejected in A/R, or carries a denial category on a payer adjustment. Categories are ModMed's buckets; the payer's own reason codes are in the "Why" panel below.

Why — the payer's own reason codes

Each denial-coded adjustment carries the remit's CARC reason code. Dollars are counted only where money actually left: written off (lost) or moved to the patient. A denial that was later reworked and paid shows as a line count, not dollars. Tap a code for the remark codes and CPTs behind it.

Written offTo patient

At risk now — open denied & rejected A/R

Open balances on denied or rejected claims, by payer, aged from date of service. Darkest = newest. Work these before they age into write-offs.

Who fights you — denial rate by payer

Share of each payer's claims with any denial event. Payers with fewer than 20 claims and no denials are omitted. Tap a row for the provider split.

How denials ended — by category and outcome

Resolved denials on the current basis: written off (lost), contractual (normal adjudication), or moved to patient responsibility.

Written offContractualTo patient

Denials over time

Dollars reaching a denial outcome by month, written-off portion in red. A cluster shows here the month it starts, not the month it is written off.

By provider

Each provider's denied claims by payer and category — open and resolved.

Production share

Attribution is ModMed Primary Provider. Procedures the owner performs on another provider's panel attribute to the owner — this view understates that provider's downstream contribution. Panel-level downstream capture is on the Panel tab.

Providers

E&M coding levels

Distribution of billed visit levels per provider vs the practice mix. A distribution with no spread — everything one level — is the pattern payer audit algorithms screen for, regardless of direction; it is also where undercoding hides.

Panels & downstream — first-touch attribution

A patient belongs to the provider who performed their first E&M visit here. A rule, not the ModMed flag — directional until the roster report exists.

Visit mix — office vs procedure

Claim-level: any claim with an E&M line is an office visit (even with a same-day procedure); procedure lines without E&M are procedure visits. Number above each bar = fluoro-guided encounters that month. Provider filter applies.

Claims-based counts — will not equal Period-Analysis encounters (different grain; both correct). Fluoro = encounters containing TFESI, facet/MBB, interlaminar ESI, SI joint, RFA, vertebral augmentation, neurostimulator, or 0627T.

Visits by provider — month to month

Same claim-level classification, one panel per provider on a shared scale. Solid = office visits, teal = procedure visits.

OfficeProcedure-only

How each provider earns

Collections mix by service line, date-of-service basis.

Procedure yield

Collected per session, add-ons collapsed, date of service. Legacy outlier claim excluded. Rows under 5 sessions suppressed.

E&M rows are visits, not procedures. Payer filter applies.

Reimbursement per unit of work — $/wRVU

Collections ÷ work RVU per code: which procedures pay well or poorly for the effort they take. Ranked against the practice procedure median. Payer filter applies.

Same procedure, different building — site of service

$/session per code per location. Office (non-facility) rates run higher by design — they must cover practice-funded supplies, staff, and fluoro; ASC/hospital professional fees are lower because the facility bills its own fee. Spreads here are structure, not errors — use them for case-siting contribution decisions, not as underpayment signals.

Cells with fewer than 5 sessions are suppressed. Outlier claim excluded throughout.

What each payer pays — per code

Contract performance by code. Pick a code; payers under 5 sessions suppressed.

Site economics

Each location as its own business unit. Collections posted-basis; $/encounter date-of-service.

Who sends the work

Tracked referral volume by referring provider, from open-claim feeds. Coverage-limited; read as directional.

Referrer quality — conversion funnel

Conversion = any procedure claim after first E&M. Days = median, first visit → first procedure. $/pt = all collections on that referrer's linked patients.

Pipeline — new vs established patients

New = 99202–99205 on the claim. The leading indicator: new-patient volume moves months before collections do.

NewEstablished

Projections — labeled, dashed, and humble

Nothing on this tab is reconciled or promised. Two layers: earned pipeline (work already done, in adjudication) and run-rate projection (work not yet performed).

2026 full-year projection

Your panel & what it generates

A patient belongs to the provider who performed their first E&M visit at the practice. Everything billed on those patients since — by you, or by the practice owner for procedures — is shown here as work your panel generated. Date-of-service basis; the flagged legacy claim excluded.

Your own procedures

Collected per session on procedures you performed yourself, add-ons collapsed. Rows under 5 sessions suppressed.

Your office — what it costs to run

Site cost by month (cash)

Site cost beside your collections — context

Your posted collections and the site's cash cost, month by month. This is context for reading the office, not a compensation calculation: nothing here is netted against you.

The business — profit & loss

QuickBooks, cash basis, reconciled to the accountant's own totals each build. Operating view excludes rental and interest income.

Operating income (month)Operating lossNet income (incl. non-operating)

Month by month — the books

Cash-basis from QuickBooks. June–July expenses include the second-office build-out (~$35–45k one-time); underlying run-rate ≈ $103–108k/mo until August books split it precisely.

Where the money goes

Categories from the COA map (94_COA_MAP in the books workbook). June–July include second-office build-out — one-time, marked on the chart above.

Income vs cost — the closing gap

IncomeOperating costNet income

Do the systems agree? — revenue bridge

Breakeven & the December question

Owner economics & balance sheet

Negative equity is the accounting shadow of SBA-funded startup losses — expected in year one and shrinking at the current pace. It is not a solvency statement; cash and A/R say otherwise.