ROI Revenue Optimization & Intelligence
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 code library
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.
Field reports

What missed revenue actually looks like.

Revenue cycle failures do not announce themselves. They hide in queues, in misclassifications, and in claims no one got around to working. Three 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 It can mean the provider's taxonomy code is incorrect or outdated, the provider type is not recognized for that service by that payer, the provider is not yet credentialed with that payer for those services, or the billing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 with adjustment code 16 and remark code M123. 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. The denial codes were vague but not wrong. A billing error and a coverage dispute require different responses. Adjustment code 16 on a claim with a missing required modifier is a billing error. It gets a corrected claim, not an appeal.

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 ↵
Pattern. Single-dose drug wastage.

Missing/incomplete/invalid HCPCS modifier on a separately payable Part B drug.

CARC 16 RARC M123
What it means
JW reports the discarded portion of a single-dose vial. JZ attests there was no discarded portion. One of the two is required on every separately payable Part B drug from a single-dose container. Missing either triggers a denial with adjustment code 16 and remark M123. The 16 alone is broad. The M123 pairing is what narrows it to a wastage-modifier issue.
Do this now
Pull the original 837. Check for JW (discarded amount) or JZ (zero discarded) on single-dose container drugs. If a modifier was missed, file a corrected claim, not an appeal.
Prevent it
Add a JW/JZ modifier check to your claim scrubber for HCPCS codes on the CMS single-dose container list. Audit administered-drug claims monthly.
Reference
CMS Transmittal 3538 (JW, effective Jan 1, 2017). CMS Transmittal 12067 / CR 13056 (JZ required Jul 1, 2023).
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

    Practice Revenue 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. What to look for. What it costs you. The risk level.

    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.

    See projection
  6. 06

    Technical Capability Library

    Six automation frameworks. Data normalizer, pre-claim eligibility checker, claim error preflight, enrollment accelerator, remittance converter, denial pattern analyzer.

    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.

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.

Access plans

Choose your level.

Simple, transparent pricing. No annual contract. Cancel anytime. Enterprise revenue cycle platforms start at $4,000 per month with a 90-day implementation. ROI starts today, at one fortieth the price.

Tier 01
$99 /mo

Basic

For solo practices systematizing denial work for the first time.

  • EDI denial & adjustment database
  • Monthly code updates
  • 5 appeal templates
  • Email support
Subscribe
Recommended
Tier 02
$199 /mo

Pro

For billing managers who want the full template library and training resources.

  • Everything in Basic
  • 25+ appeal templates
  • Payer-specific & advanced templates
  • Training video library
  • Resource Center access
Subscribe
Tier 03
$349 /mo

Premium

For practices and RCM teams that want direct expert guidance.

  • Everything in Pro
  • Monthly group Q&A call
  • 1 hr/mo private consulting
  • Custom template requests
  • Priority support
Subscribe
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.

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.

No PHI. This form is not a clinical channel.