The clinical work is happening. The billing isn't.

Most independent specialty practices leave $150,000 to $400,000 in Medicare revenue uncaptured every year. Not from billing errors — from care coordination, chronic disease management, and patient monitoring that's being delivered but never documented as the reimbursable work it is

Five areas where your practice is most likely leaving revenue uncaptured.

1.Chronic Care Management (CCM)

If your physicians are managing patients with two or more chronic conditions — and most specialty practices are — that ongoing care coordination is a billable service under Medicare. National CCM enrollment among eligible patients is below 15%. Practices that implement structured CCM programs typically recover $60–$130 per enrolled patient per month.

2. Remote Patient Monitoring (RPM) / Remote Therapeutic Monitoring (RTM)

Post-surgical patients, chronic disease management patients, and patients requiring ongoing clinical monitoring may qualify for RPM/RTM reimbursement. Fewer than 20% of eligible specialty practices have active programs — meaning most are delivering monitoring care without capturing the revenue.

3. Principal Care Management (PCM)

Principal Care Management targets patients with a single high-risk chronic condition — a lower threshold than CCM's two-condition requirement. Most specialty practices have significant qualifying patient populations but have never billed a PCM code.

4. MIPS (Merit-based Incentive Payment System)

A MIPS score below 75 means your practice is absorbing a payment penalty on every Medicare Part B claim. A score above 85 means bonus territory. Most practices don't know their current exposure — or what it would take to move the score 10–20 points.

5. Medicare Advantage Contract Profitability

Not all MA plans pay equally. Some reimburse above traditional Medicare rates for your specialty. Some pay significantly below. Without a plan-level profitability analysis, your practice may be absorbing losses on high-volume plans without knowing it.

Three Tiers — Start Where It Makes Sense

A woman in a white coat presents a strategy blueprint with graphs and a world map on a digital screen, while a man in a gray suit listens attentively in a modern office with framed certificates and mission statements on the wall.

MGO Lite

BEST FOR: SMALLER PRACTICES (2–5 PHYSICIANS), SINGLE LOCATION, WANTING TO VALIDATE THE OPPORTUNITY

A rapid, focused diagnostic that examines your Medicare billing data against CMS benchmarks to identify the highest-priority revenue gaps. You receive a clear picture of where revenue is being left on the table and a 90-day action roadmap to begin recovery.

  • CMS data pull and benchmark comparison for your specialty and geography

  • Revenue gap estimates across the five categories using available billing data

  • 90-day Quick Wins action plan with prioritized recommendations

  • Written findings summary with advisory recommendations

What's included:

Timeline: 2–3 weeks

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MGO Snapshot

BEST FOR: MID-SIZE PRACTICES WANTING DEEPER ANALYSIS BEFORE A FULL ENGAGEMENT

A deeper diagnostic that adds stakeholder interviews, detailed revenue modeling with conservative and optimistic projections, and a preliminary MA contract profitability assessment. Designed for practices that want to quantify the full opportunity before committing to a complete engagement.

  • Everything in MGO Lite

  • Two stakeholder interviews (physician lead + billing lead)

  • Detailed revenue modeling across all five categories with conservative and optimistic estimates

  • Preliminary Medicare Advantage contract profitability assessment

  • MIPS exposure analysis with score improvement pathway

  • Midpoint findings presentation

What's included:

Timeline: 3–4 weeks

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MGO Flagship

BEST FOR: PRACTICES SERIOUS ABOUT RECOVERING THE FULL SCOPE OF UNCAPTURED REVENUE

The complete Medicare Growth Optimizer™ engagement. Six weeks of structured analysis including four stakeholder interviews, comprehensive revenue modeling across all five categories, full MA contract profitability review, and a 90-minute leadership presentation with your complete findings, recommendations, and implementation roadmap.

What's included:

  • Full CMS data analysis and market benchmarking

  • Four stakeholder interviews — physician lead, practice manager, billing lead, and a targeted deep-dive

  • Complete revenue modeling for CCM, RPM, AWV, MIPS, and MA contract profitability

  • Medicare Advantage plan-level rate comparison against fee schedule benchmarks

  • Prioritized opportunity scoring (Quick Wins vs. Strategic Initiatives)

  • Written final report with executive summary, gap analysis, and implementation guidance

  • Presentation deck for leadership review

  • Standalone 90-day action plan

  • 90-minute leadership session — findings walkthrough, Q&A, next steps

Timeline: 6 weeks

Practices that examine this gap early tend to close it faster.

Start with a Discovery Call. In 30 minutes, we'll identify whether the MGO is the right fit — and which tier matches your situation.

Schedule a Discovery Call →