Healthcare Compliance & Revenue Cycle Advisory

Compliance audited.
Revenue recovered.
Your practice’s clearest prognosis.

A boutique firm for hospices, post-acute agencies, and independent practices. Fixed-fee compliance audits, specialist-level revenue cycle work, and certificate-based screening products — delivered with institutional rigor.

HFMA Member
CRCR Certified
CSBI Certified
Metro Atlanta
Practice Health Snapshot Sample Analysis
Collection Rate
43.7%
Benchmark: 95–98%
Recoverable A/R
$75,844
Within filing window
Top Denial — Payer
34.2%
Documentation mismatch
Directory Gaps
7 of 42
Across 8 major payers
Key Finding
Commercial payer denying CPT 99215 at 27.2% — MDM documentation gap identified across provider group. Coding audit found 46 claims within appeals window; remediation plan and appeal packet included.
A/R Aging Distribution
0–30 days
42%
31–60 days
25%
61–90 days
15%
90+ days
18%
HFMA Member
CSBI · Certified
Palmetto GBA · Jurisdiction M
OIG Work Plan Aligned
HIPAA Compliant
Metro Atlanta · Nationwide Remote
I
Pillar One

Performance
Coding clean. Revenue recovered.

Revenue cycle work that closes the gap between what the practice earned and what it collected. We audit coding accuracy, analyze denial patterns, recover aged A/R, and specialize in Medicare bad debt cost-report recovery and deceased-guarantor estate work — areas most RCM firms avoid because they require specialist knowledge.

  • Coding Audits (E/M, AWV, Specialty)
  • Denial Pattern Analysis
  • A/R Aging & Cash Acceleration
  • Deceased Guarantor Estate Recovery
  • Medicare Bad Debt Cost-Report Recovery
  • Financial Assistance Policy Review
  • Revenue Cycle Recovery & Aged A/R
II
Pillar Two

Protection
Compliant today. Defensible tomorrow.

Governance, compliance, and risk work that makes the practice defensible. We audit against the OIG Work Plan, the FY 2026 hospice rule, and Palmetto GBA’s current TPE edits before regulators do. We screen for OIG exclusions, verify payer directory integrity, and — for practices using AI-enabled EHRs — map AI Governance and HTI-1 Compliance obligations. Every finding has a citation. Every recommendation has a next step.

  • Hospice PPEO Readiness Assessment
  • Hospice Cap Liability & Eligibility Audit
  • ADR / TPE Response Package
  • SNF F-Tag Remediation & CoPs Gap
  • OIG Work Plan Readiness Audit
  • OIG Exclusion (LEIE) Screening
  • Provider Directory Hygiene
  • HIPAA Risk Assessment
  • AI Governance & HTI-1 Readiness
Services & Engagements

Productized where possible.
Custom where it matters.

Most engagements begin at one of three entry points: our NCCI Edit Validator (live now — check CPT code pairs in seconds), a $495 coding audit snapshot, or a hospice PPEO readiness assessment for Palmetto GBA agencies. Deeper compliance and revenue cycle work follows from what those entry points surface.

$29 – $49 / month

NCCI Edit Validator

Instant PTP edit checks and MUE lookups against CMS’s National Correct Coding Initiative. Single pair, batch validation up to 25 codes, CSV export, and API access. Q2 2026 data loaded — updated every CMS quarter.

Live Product · Try It Free ↗
$149 one-time · $49 / month

LEIE Exclusion Screening

Automated monthly OIG LEIE cross-reference of your provider, staff, contractor, and vendor roster. Institutional-voice certificate delivered to your compliance binder. No PHI required.

Productized
$495 – $3,500

Coding Audit

Three tiers — Snapshot ($495, 10 charts), Standard ($1,500, 25 charts), and Comprehensive ($3,500, 50 charts). E/M leveling, AWV documentation, MDM gaps, modifier and NCCI risk. Grounded in operator-level audit experience at a multi-provider RCM operation.

Productized · 3 Tiers
$295 – $2,195 + Maintenance

Provider Directory Hygiene

Cross-reference your provider roster against payer directories, NPPES, PECOS, and CAQH. Certificate-style deliverable flags discrepancies and effective-date mismatches. Add monthly Directory Maintenance ($99–$499/mo) to catch silent terminations before they cost you out-of-network claims.

Productized + Subscription
$1,499

Hospice PPEO Readiness

Fixed-fee readiness for hospices newly enrolled, reactivated, or under change of ownership in Georgia (or any PPEO state) since December 30, 2025. Documentation walkthrough, 10-chart audit, IDG observation, medical-director affiliation check, mock ADR packet.

Signature Engagement
$2,000 – $3,000

Cap Liability & Eligibility Audit

12-month aggregate cap projection against the FY 2026 cap ($35,361.44), 15-chart eligibility and CTI narrative audit, FY 2026 F2F attestation flexibility review, GIP length-of-stay analysis, Addendum delivery-timing review.

Hospice Specialty
$1,500 – $4,000

ADR / TPE Response Package

Document assembly, response narrative, and appeal tracking for Palmetto JM hospices and HHAs in active ADR or TPE — including Bene Sharing, Long-LOS, RHC, GIP, and F2F denial drivers.

Per-Engagement
$1,400 – $3,000

SNF F-Tag Remediation

Last three 2567s walked tag-by-tag, POC review, mock-survey interviews with DON and business office, written remediation plan with owner and deadline. F880 and F689 focus — the citation categories still driving enforcement post-Staffing-Rule repeal.

SNF Specialty
$400 / month · $4,500 / year

Compliance Subscription

Monthly regulatory bulletin (hospice + SNF + HHA + Palmetto + OIG Work Plan + Federal Register watch), quarterly 5-chart desk audit, annual mock survey, unlimited email Q&A with 2-business-day SLA. For single-site SNFs, solo hospices, and rural HHAs.

Recurring · 12-Month Prepay

Additional productized offerings — AWV Compliance Audits, HOPE Readiness, HIPAA Risk Assessment, HHA PDGM & OASIS-E2 Review, SLP KX Documentation Audit, General Practice Retainers — are available in our full catalog, delivered after a qualified discovery call.

Request Full Service Catalog
Why Prognosis

What separates
a prognosis
from a guess.

01 ·
Operator-Level RCM Experience Meets Hospice Depth
Most consultants pick one lane — RCM or compliance, hospice or outpatient, clinical or operational. Prognosis is built on operator-level experience at a multi-provider RCM operation plus the 2026 hospice regulatory reset: PPEO, HOPE, the FY 2026 cap, and Palmetto GBA’s active TPE edits. We recognize your financial and compliance problems before you finish describing them.
02 ·
Compliance Before Enforcement
The OIG Work Plan tells you what auditors will review next year. Palmetto GBA’s TPE edits tell you what they’re reviewing this quarter. The FY 2026 hospice rule and PPEO tell you where post-acute risk has concentrated. We audit against all of them — proactively — so the practice is ready before enforcement finds it.
03 ·
Proprietary Analytics, Not PowerPoint Templates
Our internal Python analytics pipeline processes denial data, A/R aging, and documentation patterns to identify issues manual review misses. Every audit finding is specific, sourced to a CFR citation or Work Plan item, and tied to a number your practice can verify.
04 ·
Findings You Can Use — With or Without Us
Most consulting audits are designed to require the consultant’s interpretation. Ours are designed to be usable. Every finding includes what the practice can fix independently, what we would do if engaged, and an honest complexity indicator. Practices that DIY become our advocates; practices that engage us know exactly what they’re buying.
05 ·
Boutique Attention. No Offshore Outsourcing.
You work with the same consultant from audit to remediation to ongoing oversight. No account managers. No offshore billing teams. The person who assessed your practice is the person who fixes it.
Your practice analysis —
delivered in 1–3 weeks.
Collection Rate 43.7% ↓
Industry Benchmark 95–98%
Revenue at Risk (Annual) $337,899
Directory Gaps 7 of 42 providers
Top Denial Risk CPT 99215 · 27.2%
OIG Exposure Level Moderate — 3 items
LEIE Status 1 Match Pending Review
Recoverable Amount $75,844
Recommended Action Coding Audit + Directory Hygiene

Sample audit output — de-identified. Actual deliverable is a written report with complexity indicators on every finding.

For Practices

Built for the practices
under the most pressure.

Different provider types face different compliance and revenue cycle pressures in 2026. We work across post-acute, behavioral health, and independent practice because the underlying methodology — fixed-fee audits, honest findings, and specialist-level remediation — applies everywhere. These are the segments where we do our deepest work.

Hospice

Hospice Agencies

PPEO readiness for hospices newly enrolled, reactivated, or under change of ownership since December 30, 2025. FY 2026 cap projection ($35,361.44) and aggregate cap liability modeling. HOPE readiness, Addendum workflow audits, IDG observation, and Palmetto GBA ADR/TPE response for Bene Sharing, Long-LOS, RHC, and GIP edits. Georgia-anchored; virtual for Arizona, California, Nevada, Ohio, and Texas PPEO agencies.

Post-Acute

Skilled Nursing Facilities

F-tag remediation focused on F880 and F689 — the citation categories driving post-Staffing-Rule enforcement. PDPM coding integrity reviews against the 34 FY 2026 ICD-10 mapping revisions. Medicare bad debt cost-report recovery for 100+ bed facilities, where MSP and dual-eligible reconciliation typically leaves six-figure recoveries on the table.

Post-Acute

Home Health Agencies

OASIS-E2 transition readiness (effective April 1, 2026), PDGM coding and HIPPS audit, F2F encounter compliance under 42 CFR 424.22, and ADR defense workflow optimization — addressing the Reason Code 56900 auto-denials that account for roughly 46% of Palmetto GBA home health denials.

Behavioral & Allied Health

Mental Health & SLP Practices

Telehealth POS and modifier compliance, rendering provider NPI integrity, SLP Part B documentation against the $2,480 KX threshold, 92500-series coding review, and the OIG Work Plan items targeting behavioral health. Fixed-fee audits sized for solo and small-group practices.

Independent Practice

DPC & Independent Primary Care

E/M leveling and AWV coding audits, denial pattern analysis by payer, Georgia DPC statute compliance, Medicare and Medicaid patient navigation, and AR aging review for practices without dedicated revenue cycle staff. Engagements sized for lean-staff operations.

Not Listed?

Other Independent Practices

If your practice doesn’t fit neatly into one of these categories, we likely still work with you. Our methodology applies broadly across independent medicine. Book a free consultation and we’ll tell you honestly whether we’re the right fit — or refer you to someone who is.

Independent medicine deserves the same operational sophistication as the health systems that tried to absorb it. You chose to practice on your own terms. Your compliance, your revenue cycle, and your documentation should work on yours too.

Prognosis Consulting · Metro Atlanta
What an Engagement Looks Like
Intake & data request
Python-driven analysis
CFR-cited findings
Complexity indicators
Walkthrough call
30-day Q&A support
$495 – $4,000 · 1–3 Weeks
Begin the Assessment

What is your practice’s
compliance prognosis?

Most independent practices and post-acute agencies are running compliance and revenue cycle workflows that haven’t been re-examined since the last major regulatory shift. Denial patterns get normalized, audit exposure compounds, and coding drift becomes invisible. A 20-minute conversation tells you whether it’s worth investigating further.

What to expect
Free 20-minute consultation — no obligation, no pitch deck.
Honest assessment of whether our services fit your situation.
If we’re the right fit, a proposal within 48 hours.
If we’re not, a referral to someone who is.
Contact
Metro Atlanta · Nationwide Remote
Serving practices nationwide — remote capable
hello@prognosisconsulting.com
Request a Free Consultation
All consultations are confidential. No PHI required at this stage.