REVENUE OPTIMIZATION

Turn Compliance Issues
Into Revenue Recovery

Stop leaving money on the table. Our AI identifies missed billing opportunities, catches documentation gaps before submission, and ensures every report meets payer-specific requirements—recovering an average of 23% more revenue.

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The Hidden Cost of Documentation Errors

Every missing field is lost revenue. Every denial is doubled work.

Insurance companies typically reimburse only 80% of ambulance charges—and that's when everything goes perfectly. Add documentation errors, missing medical necessity, or incomplete mileage logs, and that percentage drops dramatically. With denial rates averaging 15-20% industry-wide, agencies lose millions in recoverable revenue.

CareSwift's Revenue Optimization engine analyzes every report against current Medicare, Medicaid, and commercial payer requirements. We catch the missing modifiers, incomplete narratives, and documentation gaps that cause denials—before claims submission. The result? Higher first-pass acceptance rates, faster payment cycles, and recovered revenue that was previously written off.

Comprehensive Revenue Protection at Every Stage

  • Pre-Submission Optimization

    Catch issues before they become denials. Validate medical necessity documentation. Ensure all billable items captured. Verify payer-specific requirements met. Stop denials at the source.

  • Denial Pattern Analysis

    Learn from every rejection. Track denial reasons by payer. Identify systematic documentation gaps. Update rules to prevent repeat issues. Turn past denials into future revenue.

  • Retroactive Recovery

    Find money in closed charts. Identify unbilled services in past reports. Catch missed procedures and supplies. Generate amendment documentation. Recover revenue within filing deadlines.

Intelligent Revenue Capture Across All Payers

Customized validation for Medicare, Medicaid, and commercial insurance requirements

Medicare Compliance

  • Medical necessity narrative validation
  • PCS form completion verification
  • Signature requirement checks
  • Mileage documentation enforcement
  • Repetitive transport authorization tracking
  • Advanced beneficiary notice management

Commercial Payer Intelligence

  • Payer-specific requirement database
  • Prior authorization verification
  • Coverage determination logic
  • Network status validation
  • Modifier requirement checks
  • Timely filing deadline tracking

Billable Item Capture

  • Procedure code validation
  • Supply usage documentation
  • Mileage calculation accuracy
  • Wait time documentation
  • Special service identification
  • Multi-patient transport billing

Documentation Completeness

  • Chief complaint clarity
  • Assessment documentation depth
  • Treatment justification
  • Transport necessity explanation
  • Destination appropriateness
  • Physician certification status

Revenue Optimization in Action

From identification to recovery in four automated steps

  • 1.Real-Time Billing Validation

    As reports enter the system, our AI validates against current payer requirements. Missing oxygen documentation for respiratory calls? Flagged. Incomplete mileage for Medicare? Highlighted. Each issue identified includes specific remediation steps.

    Revenue Validation Engine

    Report: #4527 - BLS Transfer

    Primary Payer Detected

    Medicare Part B

    Requirements Loading

    2024 Guidelines Active

    Medical Necessity Missing

    Transport reason documented as “doctor's appointment” - insufficient for Medicare

    Required Documentation:

    • • Why ambulance transport was medically necessary
    • • Patient's condition preventing other transport
    • • Bed confinement or mobility limitations

    Revenue Impact: $425 at risk (100% denial likely)

    Mileage Documentation Incomplete

    Loaded miles: 12.3 | Point-to-point calculation: 14.7 miles

    Missing documentation for route deviation/traffic

    Revenue Impact: $28.80 potential reduction

    Signature Status

    Patient signature present | Crew signatures complete

    Receiving facility signature missing - obtain within 48 hours

    Billing Validation SummaryHigh Risk
    Medicare Requirements:2/5 Failed
    Revenue at Risk:$453.80
    Denial Probability:85%
    Action Required:Immediate
    Recommended Actions
    1. 1. Add detailed medical necessity narrative before submission
    2. 2. Document reason for mileage variance
    3. 3. Obtain receiving facility signature
    4. 4. Consider adding modifier QL if bed-confined

  • Beyond error prevention, we find hidden revenue. Procedures documented but not billed. Supplies used but not captured. Transport levels that could be upgraded based on documentation. Every opportunity quantified with dollar impact.

  • Findings flow directly to your billing team with actionable insights. Priority queues for high-value corrections. Automated worksheets for claim amendments. Direct integration with billing systems for efficiency.

    Billing Team Workflow Dashboard

    Integration: Active

    Priority Work Queue

    Auto-sorted by revenue impact

    Report #4512 - Cardiac Arrest

    Missing ALS2 documentation

    +$1,285

    If corrected

    Time to deadline: 3 days

    Report #4527 - BLS Transfer

    Medical necessity incomplete

    +$425

    At risk

    Time to deadline: 7 days

    Report #4533 - ALS Routine

    Missing supply documentation

    +$165

    Recoverable

    Time to deadline: 14 days
    Auto-Generated Worksheets

    12 amendment worksheets ready

    Direct System Export

    Ready to push to billing system

    Team Performance This Week

    47

    Issues Resolved

    $18.4K

    Revenue Recovered

    1.8 days

    Avg Resolution Time

  • Track recovery rates and denial trends over time. Update validation rules as payer requirements change. Identify provider training needs to prevent future losses. Build a culture of revenue awareness.

    Quality Improvement Dashboard

    Metrics:

    NEMSQA Performance Measures

    Above National Average
    Aspirin for Chest Pain
    94%
    12-Lead ECG Capture
    97%
    Stroke Scale Documentation
    88%
    Pain Assessment
    92%

    AHA Mission: Lifeline® STEMI Metrics

    First Medical Contact to ECG
    8.2 min
    Goal: <10 min ✓
    ECG to Cath Lab Activation
    4.1 min
    Goal: <10 min ✓
    Door to Balloon Time
    78 min
    Goal: <90 min ✓
    False Activation Rate
    3.2%
    Goal: <5% ✓

    Provider Performance Trends

    ProviderComplianceDoc TimeTrend
    Team A98%4.8 min↑
    Team B95%5.2 min↑
    Team C87%6.9 min→
    Team D94%5.5 min↑

    Automated Quality Reports

    Monthly Quality Committee Report
    Executive Performance Dashboard
    Clinical Protocol Effectiveness
    Active Improvement Initiatives
    • • Stroke scale documentation training - Team C
    • • 12-lead acquisition time reduction project
    • • Sepsis alert protocol implementation

Proven Revenue Impact

Real results from agencies maximizing their billing potential

23%
Average Revenue Increase

Through caught opportunities and reduced denials

67%
Denial Reduction

First-pass claim acceptance improvement

$380K
Annual Recovery

Average additional revenue per 1,000 transports

4.2
Day Faster Payment

Reduced payment cycle from clean claims

Your Billing Team's Force Multiplier

Even the best billing teams can't catch everything. With hundreds of payer policies, constantly changing requirements, and thousands of reports to process, some revenue inevitably slips through. Our AI serves as a safety net, catching what human review might miss.

By automating the tedious validation work, your billing staff can focus on high-value activities like appeals, payer negotiations, and process improvement. The result is not just more revenue, but a more efficient, less stressed billing department.

Every Report Reviewed.
Every Dollar Captured.
Every Time.

Discover how much revenue your agency is leaving uncollected. Upload a sample of your reports for a free revenue recovery analysis showing exactly what you're missing.

Get Your Revenue Analysis

Experience how CareSwift can transform your EMS documentation and revenue recovery with our AI-powered platform.

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