ROI That Works, Revenue cycle intelligence home
Revenue cycle intelligence. For practices, by an operator.

Decode the denial. Fix the workflow that caused it.

Every denial, decoded with a resolution path. A 100-checkpoint audit that finds the pattern in your queue. A 90-day plan you can start today.

Score your practice free, 2 minutes Browse the EDI-Code Intelligence Lab
41%

"Of medical practices now operate above a 10% denial rate. Up from 30% in 2022."

Source. Experian Health, State of Claims 2025. experian.com.
60%

"Of denied claims are never resubmitted. The revenue is already earned. Most practices never recover it."

Source. Experian Health, State of Claims 2025. experian.com.
Built for

Who this platform is for.

If you are responsible for a medical practice's revenue. Independent consultant, owner, billing manager, or the person who ended up owning both jobs. ROI was built for you.

  1. i.

    Practice-level billing owners

    Solo to group practices, one to fifteen providers, with high denial rates, aging accounts receivable, or no time to research codes. Enterprise-grade denial intelligence without the enterprise contract.

  2. ii.

    Multi-provider RCM teams

    Growing organizations where processes break under volume. The audit identifies where. The automation frameworks fix the underlying workflow gaps that create recurring losses.

  3. iii.

    Billing companies

    Revenue cycle management companies managing accounts across multiple practices. A consistent diagnostic framework, shared denial intelligence, and technical documentation deployable across your client base.

  4. iv.

    Independent RCM consultants & HIM professionals

    Freelance consultants, CDI specialists, and HIM professionals managing revenue integrity across multiple clients. A toolset that works without a dedicated IT team, deploy per-client, keep your methodology consistent.

Field reports

What missed revenue actually looks like.

Revenue cycle failures do not announce themselves. They hide in queues, in misclassifications, in documentation that stopped short of the indication, and in claims no one got around to working. Four patterns I have seen firsthand.

Pattern 01. Taxonomy denials

$40,000 in denials sitting in a queue. Nobody had looked at why.

A behavioral health practice accumulated $40,000 in denials over six months on administered medication services. The payer returned claims citing invalid taxonomy. "Invalid taxonomy" is not a single problem. It can mean the provider's taxonomy code is incorrect or outdated, the provider type is not recognized for that service by that payer, the provider is not yet credentialed with that payer for those services, or the billing reflects services outside the provider's authorized scope.

Each root cause has a different resolution path. Some are appealable. Some require a credentialing action. Some require a billing correction. The first step was identifying which problem was actually present, before deciding what to do next.

Resolution path in the EDI Lab
Pattern 02. Medicare information request

Tens of thousands in claims sitting in denials. They were not denials at all.

A multi-location practice had a large volume of claims holding in the denials queue for months. When reviewed, they were not denials in the traditional sense. Medicare was requesting information about the correct Provider ID. The practice had multiple Provider IDs associated with one location, and Medicare needed confirmation of which one applied.

This is the kind of situation that looks like a denial and gets treated like one. It is not. The response required was a letter with the correct number. Claims responded to within the required timeframe were paid. The ones that were not worked expired.

Resolution path in the EDI Lab
Pattern 03. Billing error vs. coverage dispute

Filing appeals for months on claims that needed corrected claims.

A Critical Access Hospital billing Part B drugs from single-use vials kept getting denials on administered-drug lines. They called their Medicare contractor (MAC). The MAC said file an appeal. They did. For months. Then the facility got flagged for excessive appeals.

The actual issue was a missing JW or JZ modifier on every affected claim, and one MAC had mapped that missing modifier to a payer-specific edit that did not match the standard meaning of the denial code combination it returned. A billing error and a coverage dispute require different responses. A missing required modifier is a billing error. It gets a corrected claim, not an appeal. This is a payer-policy story, not a universal pattern. The lesson: the denial code should never be the only input into your resolution workflow. When the standard fix does not match your claim, go read the payer's published policy before you touch the claim again.

See the full CARC 16 + M123 decode with the payer-policy exception
Pattern 04. Documentation integrity denial

A denial that looks like a coding problem is actually an encounter-level documentation problem.

A primary care practice was getting recurring CARC 50 denials (non-covered services, not deemed medically necessary) on a specific E&M plus procedure combination. The billing team kept appealing on medical necessity grounds. Most appeals were lost. The team escalated to coding. Coding said the codes were correct.

The actual issue lived in the chart, not in the claim. The provider was documenting the procedure but not documenting the indication that supported it. The diagnosis was correctly coded to the highest specificity allowed by the documentation, but the documentation itself stopped short of meeting the LCD requirement. Once the practice added a documentation query workflow at the encounter level (specificity of diagnosis, indication for the procedure, supporting clinical findings), the denials stopped. The pattern was upstream of billing.

Resolution path in the EDI Lab

Field reports written by Mindy Corbett, ROI. CSPO, CPC, CPB, CPPM. Twelve plus years in revenue cycle leadership. Names, identifying information, and PHI removed. Outcomes specific to each engagement.

EDI Code Intelligence Lab

A denial-code database built for the people who actually work them.

Every Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) in use today. Search by code or keyword. Each result tells you what it means, why it is happening, what to do now, how to appeal, and how to prevent it from coming back.

Every denial, decoded with a resolution path. Not a glossary. A playbook.

Search a denial code Browse all patterns
SEARCH CARC 16 + RARC M123 ↵
Sample decode. Drug detail on the claim.

Missing, incomplete, or invalid name, strength, or dosage of the drug furnished.

CARC 16 RARC M123
What it means
CARC 16 flags that the claim lacks information or has a billing error. RARC M123 narrows it to the drug detail. The usual culprits are a missing or invalid drug name, strength, or dosage, a missing or invalid NDC in loop 2410, or a mismatch between units billed and drug detail reported. A correctable billing defect, not a coverage decision.
Do this now
Obtain the drug name, strength, and dosage from the MAR or order. Populate the drug detail and NDC (loop 2410). Resubmit as a corrected claim with frequency code 7 and the payer's original claim number.
Prevent it
Add front-end edits that require complete drug detail and a valid NDC on every separately payable drug line. Audit administered-drug claims monthly.
Note
Payer-specific edits exist. Some MACs map this pairing to a different meaning in their jurisdiction. See the full decode for the payer-policy exception and how to spot it.

Open the full CARC 16 + M123 decode

The platform

A full revenue-cycle intelligence system.

Start with the assessment. Move to the audit. Build the plan. Work the queue. Stay current.

  1. 01. Start

    Revenue Health Assessment

    Seven questions. Score 0 to 100, letter grade, personalized recommendations, and links to the matching tools.

    Take the assessment
  2. 02

    Revenue Integrity Master Audit

    100 checkpoints across seven phases of the revenue cycle, including documentation integrity at the encounter level (CDI). What to look for. What it costs you. The risk level. Where denials trace back to provider query workflows, specificity of diagnosis, or pre-authorization alignment.

    Run the audit
  3. 03

    Custom 90-Day Action Plan

    Select what is broken. The platform builds a 3-phase roadmap with self-help steps and expert options.

    Build the plan
  4. 04

    Appeal Letter Templates

    Five core templates plus 25+ payer-specific. Timely filing, medical necessity, prior authorization, Coordination of Benefits (COB), bundling.

    Browse templates
  5. 05

    ROI & Pricing Calculator

    Enter volume and denial rate. Get projected recovery in 60 seconds plus a recommended service level.

    A practice with 800 claims/month at an 18% denial rate could recover an estimated $84,000–$114,000 in 90 days. Platform cost: $1,047. Net ROI: 80–109x.

    See projection
  6. 06

    ROI Automation Suite

    A connected set of automation engines plus Mission Control. Data Transformation, Provider Enrollment Velocity, Realtime Eligibility, Pre-Flight Claims, Intelligent Remittance, Denials Intelligence & Recovery, and A/R Command.

    Read the docs
How it works

Three steps to revenue integrity.

Diagnose, fix, sustain. Run the loop quarterly.

  1. i.

    Diagnose

    Run the Master Audit to baseline your revenue cycle. Use the EDI Lab to decode your top denial codes and surface root cause.

  2. ii.

    Fix

    Build a Custom 90-Day Action Plan for your specific issues. Use the appeal templates and self-help steps to start recovering immediately.

  3. iii.

    Sustain

    Re-run the audit quarterly. Monitor key performance indicators. Use the automation frameworks to eliminate manual rework and prevent regression.

The difference

Revenue cycle intelligence, not another billing system.

Systems like eClinicalWorks, Waystar, athenahealth, Tebra, and AdvancedMD process and track claims. ROI tells you why those systems are failing, and what to do about it.

What billing & EHR systems do What ROI does on top
Purpose Process and submit claims. Track status. Log denials. Diagnose why claims are failing. Decode every denial with a resolution path.
Audit Reports on what happened. A structured 100-checkpoint audit across seven revenue-cycle phases.
Implementation Enterprise contract. IT project. 60 to 120 days. Migration risk. Day one. No integration. No annual contract. No IT dependency.
Denial intelligence Logs the code. No pattern analysis. Pattern analysis built in. Root cause for every code. Cross-linked appeal templates.
Cost $4k to $25k+ per month, plus implementation. Starts at $99 per month. Cancel anytime.
By specialty

Denial patterns are not universal.

Every specialty bills differently, gets denied differently, and needs a different appeal playbook.

Browse all specialty guides

Behavioral Health

Parity enforcement, prior-authorization workflows, and the 62 to 82% appeal-win rate at the Independent Review Organization (IRO).

Dermatology

Modifier 25, X modifiers, bundling edits, and cosmetic vs. medical-necessity documentation.

Physical Therapy

The 8-minute rule, plan-of-care certification, National Correct Coding Initiative (NCCI) edits, and the 2026 $2,480 KX threshold.

Ambulatory Surgery

Implants, place of service 24 vs. 22, multiple-procedure reductions, and the CY 2026 ASC rule updates.

Ophthalmology

Bilateral procedures, modifier 50 vs. LT/RT, cataract bundling, and the retinal imaging denials that eat operating margin.

Orthopedics

Global surgical periods, modifier 24, 25, 57, 58, 78, 79, DME billing, and the fracture care coding rules.

Coming soon

Multi-specialty groups & health systems

Running revenue cycle across many specialties under one taxonomy. Shared denial intelligence, per-specialty payer rules, cross-service-line audit tracking, and how to keep documentation integrity consistent at scale.

Coming soon

Primary Care

Modifier 25 with E&M plus procedure, preventive vs. problem-oriented visits, chronic care management, transitional care management, and the encounter-level documentation gaps behind LCD denials.

Questions

Before you subscribe.

Does ROI integrate with my EHR?

EHR-agnostic by design. ROI works on top of whatever system you already use. No migration, no IT project, no compatibility requirement. You bring the denial data. ROI provides the intelligence framework to work it.

Payers are using AI to deny claims. How does ROI help?

Payers now deny in seconds. Denial rates are at a decade high as a direct result. ROI gives your team decoded denial patterns, audit checkpoints, and appeal templates calibrated to current payer behavior. No enterprise contract. You can be working denials today.

We already have a billing team. Why do we need this?

ROI is designed to work alongside your billing team, not replace it. Most teams are managing claims volume, not conducting structured denial-pattern analysis. ROI gives them a systematic audit layer, denial intelligence tools, and appeal frameworks that were not part of the original process.

Is ROI HIPAA compliant? Do I need a Business Associate Agreement?

ROI does not process, store, or transmit PHI. No Business Associate Agreement (BAA) is required to use the platform. For consulting engagements where PHI may be involved, a BAA is executed before any information is shared. See the Security page for full details.

Does ROI address Clinical Documentation Improvement (CDI), or only post-denial recovery?

Both. The 100-checkpoint audit includes encounter-level documentation integrity checkpoints (specificity of diagnosis, indication for procedure, pre-authorization alignment, provider query workflow). Many denials that look like coding or billing problems are upstream documentation problems. The audit traces them back. The EDI Lab maps denial codes to documentation root causes when that is where the failure lives, so the fix happens at the encounter, not in an appeal cycle. See Pattern 04 in Field Reports for a worked example.

Get the score

The intelligence to fix what others just log.

Every denial decoded. 100 audit checkpoints mapped. A 90-day action plan built around your specific challenges. Score in under two minutes.

Run the free assessment

No credit card. No PHI. 2 min.

The Dispatch · Monthly

Revenue intelligence for independent practices.

One email a month. Specific denial patterns, primary-source policy notes, and what to do about them. No fluff.

Read the latest issue →

No PHI. This form is not a clinical channel.